Provider Demographics
NPI:1205011012
Name:LYDIA'S HOME
Entity Type:Organization
Organization Name:LYDIA'S HOME
Other - Org Name:LYDIA'S HOME, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-855-6937
Mailing Address - Street 1:2704 GRIMSLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3138
Mailing Address - Country:US
Mailing Address - Phone:336-456-7248
Mailing Address - Fax:
Practice Address - Street 1:716 PRINCE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2430
Practice Address - Country:US
Practice Address - Phone:336-370-6315
Practice Address - Fax:336-316-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness