Healthcare Provider Details

I. General information

NPI: 1457043044
Provider Name (Legal Business Name): REVIVE TREATMENT CENTER - HOFFMAN ESTATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 HASSELL RD STE 115
HOFFMAN ESTATES IL
60169-2170
US

IV. Provider business mailing address

2353 HASSELL RD STE 115
HOFFMAN ESTATES IL
60169-2170
US

V. Phone/Fax

Practice location:
  • Phone: 847-220-2438
  • Fax:
Mailing address:
  • Phone: 847-220-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARON FRIEDMAN
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 847-220-2438