Provider Demographics
NPI:1508088410
Name:LYDIA HEALTHCARE
Entity Type:Organization
Organization Name:LYDIA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-455-9696
Mailing Address - Street 1:13901 S LYDIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:IL
Mailing Address - Zip Code:60472-2215
Mailing Address - Country:US
Mailing Address - Phone:708-385-8700
Mailing Address - Fax:708-385-5648
Practice Address - Street 1:13901 S LYDIA AVE
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:IL
Practice Address - Zip Code:60472-2215
Practice Address - Country:US
Practice Address - Phone:708-385-8700
Practice Address - Fax:708-385-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid