1619129715 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 1619129715 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:
AID- TAC HOUSE
Provider Other Organization Name Type Code:
5
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:
1619129715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 W. NEW INDIAN TRAIL COURT
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:
60506-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-966-4168
Provider Business Mailing Address Fax Number:
630-844-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N CONSTITUTION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-859-7650
Provider Business Practice Location Address Fax Number:
630-859-1780
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
O'SHEA
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-966-4001

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  0034108 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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