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General NPI Number Information
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NPI Number | 1619113974
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Entity Type | Organization
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Legal Business Name | RECOVERY OPTIONS OF CHAMPAIGN COUNTY LTD
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 2917 B1 CROSSING COURT
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City | CHAMPAIGN
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State | IL
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Zip | 61822
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Country | US
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Telephone | 217-344-2740
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Fax | 217-344-2819
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Provider Business Mailing Address
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Address Line | 2917 B1 CROSSING COURT
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City | CHAMPAIGN
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State | IL
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Zip | 61822
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Country | US
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Telephone | 217-344-2740
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Fax | 217-344-2819
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Authorized Official
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Title or Position | EX DIRECTOR
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Name | JOHN AUSTIN PETERSON
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Credential | MD
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Telephone | 217-344-2740
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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 | 036083081
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License Number State | IL
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