| Aunt Martha's Youth Service Center Inc | |
|
1301 Copperfield Avenue Suite 201 Joliet IL 60432-2056 | |
| (708) 747-7100 | |
| Not Available |
| Full Name | Aunt Martha's Youth Service Center Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1301 Copperfield Avenue, Joliet, 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 Highway Olympia Fields IL 60461-1021 Ph: (708) 747-7100 | Aunt Martha's Youth Service Center Inc 1301 Copperfield Avenue Suite 201 Joliet IL 60432-2056 Ph: (708) 747-7100 |
| NPI Number | 1174809503 |
|---|---|
| Provider Enumeration Date | 10/31/2011 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174809503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 077 (Illinois) | Primary |
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Aunt Martha's Youth Service Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 Eagle Street, Joliet, IL 60432 Phone: 708-747-7100 Fax: 708-747-0710 | |
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