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General NPI Number Information
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NPI Number | 1639614175
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Entity Type | Organization
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Legal Business Name | MATHERS RECOVERY LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 420 AIRPORT RD STE C
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City | ELGIN
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State | IL
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Zip | 60123-9329
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Country | US
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Telephone | 815-444-9999
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Fax | 815-986-1363
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Provider Business Mailing Address
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Address Line | 145 S VIRGINIA ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7226
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Country | US
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Telephone | 815-444-9999
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Fax | 815-986-1363
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Authorized Official
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Title or Position | CFO
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Name | SRIHARI VEMURI
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Credential |
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Telephone | 815-444-9999
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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 | IL
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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