Provider Demographics
NPI:1124568431
Name:ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Entity Type:Organization
Organization Name:ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-966-4001
Mailing Address - Street 1:504 E DIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-2417
Mailing Address - Country:US
Mailing Address - Phone:847-931-2340
Mailing Address - Fax:815-344-2497
Practice Address - Street 1:504 E DIGGINS ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2417
Practice Address - Country:US
Practice Address - Phone:847-931-2340
Practice Address - Fax:815-344-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health