Provider Demographics
NPI:1053563007
Name:ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Entity type:Organization
Organization Name:ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Other - Org Name:
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 COURT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2494
Mailing Address - Country:US
Mailing Address - Phone:630-966-4168
Mailing Address - Fax:630-844-2065
Practice Address - Street 1:1305 E. NEW INDIAN TRAIL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505
Practice Address - Country:US
Practice Address - Phone:630-966-4290
Practice Address - Fax:630-978-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL726880Medicare PIN