| Aunt Martha's Youth Service Center, Inc. | |
|
17850 Kedzie Ave Suite 3200 Hazel Crest IL 60429-2058 | |
| (708) 335-5201 | |
| Not Available |
| Full Name | Aunt Martha's Youth Service Center, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 17850 Kedzie Ave, Hazel Crest, Illinois |
| Authorized Official Name and Position | Christopher J Nordloh (CFO) |
| Authorized Official Contact | 7087477100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aunt Martha's Youth Service Center, Inc. 19990 Governors Hwy Olympia Fields IL 60461-1021 Ph: (708) 747-7100 | Aunt Martha's Youth Service Center, Inc. 17850 Kedzie Ave Suite 3200 Hazel Crest IL 60429-2058 Ph: (708) 335-5201 |
| NPI Number | 1104054386 |
|---|---|
| Provider Enumeration Date | 06/26/2009 |
| Last Update Date | 12/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104054386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Varsha Bhan Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 17850 Kedzie Ave, Suite 1700, Hazel Crest, IL 60429 Phone: 708-669-1630 Fax: 708-799-2261 | |
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Aunt Martha's Youth Service Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17850 S Kedzie Ave, Hazel Crest, IL 60429 Phone: 708-747-7100 | |
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