Organization
LYDIA HOME ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN CLUTTER (DIRECTOR OF FINANCE)
(847) 651-7195
Entity
Organization
Contact information
Practice address
1101 WASHINGTON ST, EVANSTON, IL 60202-1619
(847) 424-2450
Mailing address
4300 W IRVING PARK RD, CHICAGO, IL 60641-2825
(773) 736-1447
(773) 736-5014
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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