| Organization Name: | AUNT MARTHAS YOUTH SERVICE |
| NPI Number: | 1013045707 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY M MARTIN (CONTROLLER) |
| Mailing Address: | 19990 Governors Hwy Olympia Fields |
| State: | IL US |
| Postal Code: | 604611021 |
| Phone Number: | 7087477100 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2007 |
| NPI Last Update Date: | 04/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | =========041 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |