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General NPI Number Information
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NPI Number | 1619129715
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Entity Type | Organization
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Legal Business Name | ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 421 N CONSTITUTION DR
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City | AURORA
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State | IL
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Zip | 60506-3209
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Country | US
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Telephone | 630-859-7650
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Fax | 630-859-1780
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Provider Business Mailing Address
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Address Line | 309 W. NEW INDIAN TRAIL COURT
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City | AURORA
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State | IL
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Zip | 60506-2494
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Country | US
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Telephone | 630-966-4168
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Fax | 630-844-2065
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LYNN O'SHEA
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Credential |
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Telephone | 630-966-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 0034108
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License Number State | IL
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