AUNT MARTHAS YOUTH SERVICE CENTER NPI 1295863983

NPI Information

NPI: 1295863983
Provider Name: AUNT MARTHAS YOUTH SERVICE CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
5001 S MICHIGAN AVE
CHICAGO, IL
ZIP 60615
Phone: (708) 747-7100
Get Directions

AUNT MARTHAS YOUTH SERVICE CENTER is a federally qualified health center (fqhc) clinic center in Chicago, IL. AUNT MARTHAS YOUTH SERVICE CENTER NPI is 1295863983. The provider is registered as an organization entity type.

The provider's business location address is:

5001 S MICHIGAN AVE
CHICAGO, IL
ZIP 60615-112
Phone: (708) 747-7100

The provider's authorized official is Christopher J Nordloh .
The authorized official title is Cfo and has the following contact phone number (708) 747-7100.

The enumeration date for this NPI number is 3/2/2007 and was last updated on 12/2/2010.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	=========043	ILLINOIS	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========043	MEDICAID	ILLINOIS

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

NPI Synchronization or Removal

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