AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER – NPI #1174070676
Clinic/Center

AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER is an AHC clinic located in BLUE ISLAND, IL. NPPES has assigned the NPI number 1174070676 to AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER on September 01, 2016. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER” is a dba name, the actual legal business name for this organization is AUNT MARTHA'S YOUTH SERVICE CENTER. The primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 9 years ago on Jan 13, 2017. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER below.

NPI Profile for
AUNT MARTHA'S YOUTH SERVICE CENTER

NPI Number
1174070676
Enumeration Date

(about 10 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
AUNT MARTHA'S YOUTH SERVICE CENTER
Doing Business As (dba): AUNT MARTHA'S BLUE ISLAND COMMUNITY HEALTH CENTER
Primary location
12139 S. WESTERN AVE
BLUE ISLAND, IL 60406
Phone: (877) 692-8686 Fax:
Mailing address
19900 GOVERNORS DR
OLYMPIA FIELDS, IL 60461-1057
Phone: Fax:
Organization Subpart
No
Authorized Official
AUDREY PENNINGTON
EXECUTIVE VP OF HEALTH
Phone: (773) 802-7645
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.