Healthcare Provider Details

I. General information

NPI: 1801723820
Provider Name (Legal Business Name): LAKE HARBOR BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 W OGLESBY AVE
GURNEE IL
60031-3358
US

IV. Provider business mailing address

3915 W OGLESBY AVE
GURNEE IL
60031-3358
US

V. Phone/Fax

Practice location:
  • Phone: 772-404-7642
  • Fax: 772-303-3434
Mailing address:
  • Phone: 772-404-7642
  • Fax: 772-303-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HALL
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 772-240-6190