Lydias House

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

LYDIAS HOUSE

Practice address

11667 152ND Ave
West Olive, MI 49460-9232

Phone

(616) 844-3059

NPI assigned

Apr 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lydia Hodges

Title

Owner

Phone

(616) 844-3059

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1659990208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11667 152ND AVE",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494609232",
            "telephone_number": "616-844-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11667 152ND AVE",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494609232",
            "telephone_number": "616-844-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIAS HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-844-3059"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in West Olive, MI by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.