Organization · Type 2 NPI
Aunt Martha's Youth Service Center, Inc
Federally Qualified Health Center (FQHC) · Park Forest, IL
NPI number
1780828962
Active
Practice location
23485 Western Ave
Park Forest, IL 60466-2609
Mailing address
19990 Governors Hwy
Olympia Fields, IL 60461-1021
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Federally Qualified Health Center (FQHC) Primary | 261QF0400X | None listed |
Federally Qualified Health Center (FQHC): Definition to come...
About NPI 1780828962
Aunt Martha's Youth Service Center, Inc's National Provider Identifier is 1780828962, issued on May 1, 2009. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Park Forest, IL. The record was last updated on Dec 2, 2010.