Healthcare Provider Details

I. General information

NPI: 1770466641
Provider Name (Legal Business Name): NORTHERN ILLINOIS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N STATE ROUTE 31 STE A
CRYSTAL LAKE IL
60012-3716
US

IV. Provider business mailing address

620 N STATE ROUTE 31
CRYSTAL LAKE IL
60012-3714
US

V. Phone/Fax

Practice location:
  • Phone: 815-261-3450
  • Fax: 815-261-3451
Mailing address:
  • Phone: 815-261-3450
  • Fax: 815-261-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS HOWELL
Title or Position: CEO
Credential:
Phone: 815-261-3450