| Aunt Martha's Youth Service Center, Inc | |
|
23485 Western Ave Park Forest IL 60466-2609 | |
| (708) 747-7100 | |
| Not Available |
| Full Name | Aunt Martha's Youth Service Center, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 23485 Western Ave, Park Forest, 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 23485 Western Ave Park Forest IL 60466-2609 Ph: (708) 747-7100 |
| NPI Number | 1780828962 |
|---|---|
| Provider Enumeration Date | 05/01/2009 |
| Last Update Date | 12/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780828962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Park Forest Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 344 Victory Dr, Park Forest, IL 60466 Phone: 708-481-0100 | |
Grand Prairie Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Sandburg St, Park Forest, IL 60466 Phone: 708-444-1012 |