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General NPI Number Information
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NPI Number | 1942182662
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Entity Type | Organization
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Legal Business Name | REVIVE TREATMENT CENTER - LAKE ZURICH LLC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 365 SURRYSE RD STE 120
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2679
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Country | US
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Telephone | 847-320-1133
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Fax | 312-757-6869
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Provider Business Mailing Address
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Address Line | 365 SURRYSE RD STE 120
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2679
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Country | US
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Telephone | 847-320-1133
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Fax | 312-757-6869
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | ARON FRIEDMAN
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Credential |
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Telephone | 847-220-8884
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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