Organization · Type 2 NPI

Aunt Martha's Youth Service Center, Inc.

Federally Qualified Health Center (FQHC) · Hazel Crest, IL

NPI number 1104054386 Active

Practice location

17850 Kedzie Ave, Suite 3200
Hazel Crest, IL 60429-2058

Mailing address

19990 Governors Hwy
Olympia Fields, IL 60461-1021

Specialties and licenses

TaxonomyCodeLicense
Federally Qualified Health Center (FQHC) Primary 261QF0400XNone listed

Federally Qualified Health Center (FQHC): Definition to come...

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About NPI 1104054386

Aunt Martha's Youth Service Center, Inc.'s National Provider Identifier is 1104054386, issued on Jun 26, 2009. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Hazel Crest, IL. The record was last updated on Dec 2, 2010.