Provider Demographics
NPI:1144000266
Name:NORTHERN ILLINOIS RECOVERY LLC
Entity type:Organization
Organization Name:NORTHERN ILLINOIS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-261-3450
Mailing Address - Street 1:620 N STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3714
Mailing Address - Country:US
Mailing Address - Phone:815-261-3450
Mailing Address - Fax:815-261-3451
Practice Address - Street 1:2602 IL ROUTE 176
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-2225
Practice Address - Country:US
Practice Address - Phone:815-261-3450
Practice Address - Fax:815-261-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility