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AUNT MARTHA'S YOUTH SERVICE CENTER INC NPI 1063678530


NPI Information

NPI: 1063678530
Provider Name: AUNT MARTHA'S YOUTH SERVICE CENTER INC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 14D1020896

Address:
1941 SELMARTEN RD
AURORA, IL
ZIP 60505
Phone: (708) 754-1044
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AUNT MARTHA'S YOUTH SERVICE CENTER INC is a federally qualified health center (fqhc) clinic center in Aurora, IL. AUNT MARTHA'S YOUTH SERVICE CENTER INC NPI is 1063678530. The provider is registered as an organization entity type.

The provider's business location address is:

1941 SELMARTEN RD
AURORA, IL
ZIP 60505-337
Phone: (708) 754-1044

The provider's authorized official is Jerry Garvey .
The authorized official title is Cfo and has the following contact phone number (708) 754-1044.

The CLIA number assigned to this NPI record is 14D1020896 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/4/2008 and was last updated on 8/4/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)=========048ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1=========048MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.