| Organization Name: | AUNT MARTHAS YOUTH SERVICE CTR |
| NPI Number: | 1184826422 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD GARVEY (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 233 W Joe Orr Rd Chicago Heights |
| State: | IL US |
| Postal Code: | 604111744 |
| Phone Number: | 7087541044 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | =========002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |