# LYDIA HOME ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235197583
- **Authorized official:** MR. DAVID KARL ANDERSON PSYD (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (773) 736-1447

## Contact information

- **Practice address:** 4300 W IRVING PARK RD, CHICAGO, IL 60641-2825
- **Practice address phone:** (773) 736-1447
- **Practice address fax:** (773) 736-5014
- **Mailing address:** 4300 W IRVING PARK RD, CHICAGO, IL 60641-2825
- **Mailing address phone:** (773) 736-1447
- **Mailing address fax:** (773) 736-5014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 062837 | IL | Yes |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 06/24/2022