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General NPI Number Information
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NPI Number | 1144000266
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS RECOVERY LLC
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 2602 IL ROUTE 176
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-2225
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Country | US
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Telephone | 815-261-3450
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Fax | 815-261-3451
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Provider Business Mailing Address
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Address Line | 620 N STATE ROUTE 31
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-3714
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Country | US
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Telephone | 815-261-3450
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Fax | 815-261-3451
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Authorized Official
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Title or Position | CEO
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Name | NICHOLAS HOWELL
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Credential |
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Telephone | 815-261-3450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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