AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
NPI 1205386638
Clinic/Center - Federally Qualified Health Center (FQHC) in Harvey, IL

NPI Status: Active since October 10, 2016

Contact Information

15420 DIXIE HWY
HARVEY, IL
ZIP 60426
Phone: (877) 692-8686

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  • Organization
  • Clinic/Center
  • Federally Qualified Health Center (FQHC)
  • CLIA Number: 14D2134319
  • CLIA Cert. Type: Federally Qualified Health Center
  • CLIA Exp. Date: 07-30-2025

About AUNT MARTHA'S YOUTH SERVICE CENTER, INC.

This page provides the complete NPI Profile along with additional information for Aunt Martha's Youth Service Center, Inc., a primary care provider established in Harvey, Illinois operating as a Clinic/center, focusing in federally qualified health center (fqhc) . The healthcare provider is registered in the NPI registry with number 1205386638 assigned on October 2016. The practitioner's primary taxonomy code is 261QF0400X. The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is Audrey Pennington (Executive Vp Of Health)

NPI
1205386638
Provider Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Entity Type
Organization
Location Address
15420 DIXIE HWY HARVEY, IL 60426
Location Phone
(877) 692-8686
Mailing Address
19990 GOVERNORS HWY OLYMPIA FIELDS, IL 60461
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
10-10-2016
Last Update Date
10-10-2016
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A primary care provider (PCP) like Aunt Martha's Youth Service Center, Inc. sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Federally Qualified Health Center (FQHC)

Taxonomy Code
261QF0400X
Type
Ambulatory Health Care Facilities

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

AUDREY PENNINGTON

Authorized Official Title
EXECUTIVE VP OF HEALTH
Authorized Official Phone
(773) 802-7645

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
14D2134319
Facility Type
Federally Qualified Health Center
Certificate Effective Date
July 31, 2023
Certificate Expiration Date
July 30, 2025
Laboratory Director
CHARLES BARRON MD
Certificate Type
Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description
This CLIA certificate is issued to Aunt Martha's Youth Service Center, Inc. in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1205386638
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2205681266
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 0 + 5 + 6 + 8 + 1 + 2 + 6 + 6 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1205386638 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1619427655AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Organization
Clinic/Center (Federally Qualified Health Center (FQHC))15420 DIXIE HWY
HARVEY, IL 60426
(877) 692-8686

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1205386638, enumerated in the NPI registry as an "organization" on October 10, 2016

The provider is located at 15420 Dixie Hwy Harvey, Il 60426 and the phone number is (877) 692-8686

This medical organization specializes in Clinic/Center with taxonomy code 261QF0400X with a focus in Federally Qualified Health Center (FQHC)

The provider's CLIA number is 14D2134319 for a "federally qualified health center" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..

This NPI record was last updated on October 10, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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