# LYDIA HOME ASSOCIATION

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

## Provider details

- **NPI number:** 1962123901
- **Authorized official:** BRIAN CLUTTER (DIRECTOR OF FINANCE)
- **Authorized official phone:** (847) 651-7195

## Contact information

- **Practice address:** 1101 WASHINGTON ST, EVANSTON, IL 60202-1619
- **Practice address phone:** (847) 424-2450
- **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 |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 09/08/2022
- **Last updated:** 09/08/2022