Organization
LIFEHOUSE RECOVERY ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL WALSH NCRS, MBA (CEO)
(312) 451-5996
Entity
Organization
Contact information
Practice address
14127 LEAVITT AVE, DIXMOOR, IL 60406
(312) 451-5996
Mailing address
14127 LEAVITT AVE, DIXMOOR, IL 60406
(312) 451-5996
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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