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General NPI Number Information
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NPI Number | 1548013121
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Entity Type | Organization
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Legal Business Name | PURPLE CLOVER RECOVERY
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 444 S RAND RD STE 211
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2307
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Country | US
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Telephone | 224-475-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 444 S RAND RD STE 211
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2307
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Country | US
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Telephone | 224-475-1223
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BRANDON LIPIN
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Credential | PSYD
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Telephone | 224-475-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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