LYDIA HOME ASSOCIATION NPI 1235197583

NPI Information

NPI: 1235197583
Provider Name: LYDIA HOME ASSOCIATION
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization

CLIA Number: 14D2214653

Address:
4300 W IRVING PARK RD
CHICAGO, IL
ZIP 60641
Phone: (773) 736-1447
Get Directions

LYDIA HOME ASSOCIATION is a residential treatment facility emotionally disturbed children in Chicago, IL. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. LYDIA HOME ASSOCIATION NPI is 1235197583. The provider is registered as an organization entity type.

The provider's business location address is:

4300 W IRVING PARK RD
CHICAGO, IL
ZIP 60641-825
Phone: (773) 736-1447
Fax: (773) 736-5014

The provider's authorized official is David Karl Anderson .
The authorized official title is Executive Director and has the following contact phone number (773) 736-1447.

The CLIA number assigned to this NPI record is 14D2214653 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2006 and was last updated on 3/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health			No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health			No
3	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		062837	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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