MEDICARE: THE DIVERSITY OF YOUTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588520431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIVERSITY OF YOUTH CORP

Provider Business Mailing Address
First Line	:	14750 KEYSTONE AVE
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3332
Country	:	US
Telephone Number	:	563-564-0843
Fax Number	:

Provider Business Practice Location Address
First Line	:	966 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-7814
Country	:	US
Telephone Number	:	563-564-0843
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GABRIELLE TYEPTANAR
Credential	:
Telephone Number	:	563-564-0843

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	02/09/2026

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Directions to “THE DIVERSITY OF YOUTH CORP ” Practice Location

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