Healthcare Provider Details

I. General information

NPI: 1770144925
Provider Name (Legal Business Name): ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N HIGHLAND AVE
AURORA IL
60506-1401
US

IV. Provider business mailing address

309 NEW INDIAN TRAIL CT
AURORA IL
60506-2411
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-1291
  • Fax: 630-859-2994
Mailing address:
  • Phone: 630-966-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: FRANCES L. BAKER
Title or Position: PRESIDENT
Credential:
Phone: 630-966-4001