Provider Demographics
NPI:1528556669
Name:ASSOCIAITON FOR INDIVIDUAL DEVELOPMENT
Entity type:Organization
Organization Name:ASSOCIAITON FOR INDIVIDUAL DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-966-4001
Mailing Address - Street 1:309 NEW INDIAN TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2411
Mailing Address - Country:US
Mailing Address - Phone:630-966-4000
Mailing Address - Fax:630-844-2065
Practice Address - Street 1:304 N 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3484
Practice Address - Country:US
Practice Address - Phone:630-966-4475
Practice Address - Fax:630-892-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)