AUNT MARTHA'S YOUTH SERVICE CENTER (NPI# 1174070676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174070676 |
| Entity Type | Organization |
| Organization Name | AUNT MARTHA'S YOUTH SERVICE CENTER |
| Other Organization Name | AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER |
| Practice Address |
12139 S. Western Ave Blue Island IL 60406 |
| Mailing Address |
19900 Governors Dr Olympia Fields IL 60461-1057 |
| Practice Telephone | 8776928686 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2017-01-13 |
| Authorized Official Name | AUDREY PENNINGTON (EXECUTIVE VP OF HEALTH) |
| Authorized Official Telephone | 7738027645 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Aunt Martha's Blue Island Community Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861637878 | Aunt Martha's Youth Service Center | Community/Behavioral Health | 440 Forest Blvd, Park Forest, IL 60466-2002 | 2008-12-04 |
| 1720258619 | Aunt Martha's Youth Service Center | Community/Behavioral Health | 15020 Cicero Ave, Suite D, Oak Forest, IL 60452-1441 | 2008-03-06 |
| 1295835023 | Aunt Martha's Youth Service Center | Clinic/Center | 8640 S South Chicago Ave, Chicago, IL 60617-2314 | 2006-09-22 |
| 1710424916 | Aunt Martha's Youth Service Center | Clinic/Center | 15350 Oak Park Ave, Oak Forest, IL 60452-1500 | 2017-01-25 |
| 1962949230 | Aunt Martha's Youth Service Center | Clinic/Center | 8640 S South Chicago Ave, Chicago, IL 60617-2314 | 2017-01-25 |
| 1427508464 | Aunt Martha's Youth Service Center | Clinic/Center | 812 N Logan Ave, Danville, IL 61832-3752 | 2016-10-13 |
| 1982150983 | Aunt Martha's Youth Service Center | Clinic/Center | 511 Dundee Ave, East Dundee, IL 60118-1642 | 2016-08-30 |
| 1912452483 | Aunt Martha's Youth Service Center | Clinic/Center | 3703 Doty Rd, Mob 1, Suite 1, Woodstock, IL 60098-7517 | 2016-08-24 |
| 1851626089 | Aunt Martha's Youth Service Center | Clinic/Center | 755 Pulaski Rd, Calumet City, IL 60409-4030 | 2009-10-06 |
| 1568638500 | Aunt Martha's Youth Service Center | Case Management | 191 W 155th Pl, Harvey, IL 60426-3413 | 2008-04-30 |
| Street Address |
12139 S. WESTERN AVE |
| City | BLUE ISLAND |
| State | IL |
| Zip Code | 60406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1942842810 | Blue Island Smiles PC | Dentist | 12059 Western Avenue, Blue Island, IL 60406 | 2019-10-12 |
| 1609438738 | Maisha Safford | Developmental Therapist | 2262 W. 120th Place, Blue Island, IL 60406 | 2019-06-28 |
| 1891279709 | Renjith Thomas | Physical Therapy Assistant | Therapy Department, 1546 W Water Stret, Blue Island, IL 60406 | 2018-09-18 |
| 1982182994 | Lifehouse Health Group,llc | Clinic/Center | 14127 Levitt Ave, Dixmoor, IL 60406 | 2018-08-01 |
| 1063923159 | Sarah Lynn Presser | Speech-Language Pathologist | 2975 W Broadway, Blue Island, IL 60406 | 2017-10-17 |
| 1427429141 | Pamela Kilcrease | Case Manager/Care Coordinator | 2247 119th Street, Apt 6, Blue Island, IL 60406 | 2015-10-08 |
| 1639587025 | D2 Dental At Oak Street, P.C. | Dentist | 3046 West 127th Street, Blue Island, IL 60406 | 2014-07-29 |
| 1700299658 | Daniel Ahrens | Optometrist | 13114 S Western Ave, Blue Island, IL 60406 | 2014-06-09 |
| 1396017984 | Abbas M.b Ibrahim Sr. | Physician Assistant | 12935 S Gregory Street, Blue Island, IL 60406 | 2012-01-30 |
| Find all providers in zip 60406 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114005337 | Access Community Health Network | Clinic/Center | 13000 Maple Ave, Blue Island, IL 60406-2318 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417567108 | Pillars Community Health | Clinic/Center | 15w458 91st St, Burr Ridge, IL 60527-6379 | 2020-08-06 |
| 1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
| 1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
| 1639791569 | Community Health Partnership of Illinois | Clinic/Center | 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 | 2020-05-14 |
| 1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
| 1235769704 | Greater Elgin Family Care Center | Clinic/Center | 451 N Mclean Blvd, Elgin, IL 60123-3239 | 2020-01-23 |
| 1710517537 | Greater Elgin Family Care Center Integrated Health Home | Clinic/Center | 1100 Shirley Ave, Streamwood, IL 60107-3068 | 2020-01-21 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
| City | BLUE ISLAND |
| Zip Code | 60406 |
Please comment or provide details below to improve the information on AUNT MARTHA'S YOUTH SERVICE CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.