Healthcare Provider Details

I. General information

NPI: 1609615558
Provider Name (Legal Business Name): ROTARY RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DUNDEE RD STE 504
NORTHBROOK IL
60062-2449
US

IV. Provider business mailing address

2360 LAKEWOOD ROAD SUITE 2 NUM 164
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 847-595-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOEL BERNATH
Title or Position: CEO
Credential:
Phone: 847-595-1300