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Organization
LYDIA HOME ASSOCIATION
Active
Organization
LYDIA HOME ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID KARL ANDERSON PSYD (EXECUTIVE DIRECTOR)
(773) 736-1447
Entity
Organization
Contact information
Practice address
4300 W IRVING PARK RD, CHICAGO, IL 60641-2825
(773) 736-1447
(773) 736-5014
Mailing address
4300 W IRVING PARK RD, CHICAGO, IL 60641-2825
(773) 736-1447
(773) 736-5014
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
062837
IL
Other
Enumeration date
05/03/2006
Last updated
06/24/2022
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