1538784293 NPI number — ASSOCIATION FOR INDIVIDUAL DEVELOPMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538784293 NPI number — ASSOCIATION FOR INDIVIDUAL DEVELOPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538784293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 NEW INDIAN TRAIL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-966-4000
Provider Business Mailing Address Fax Number:
630-844-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 LARKIN AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-6082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-281-4952
Provider Business Practice Location Address Fax Number:
847-608-1007
Provider Enumeration Date:
06/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-966-4001

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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