Organization
GROUPS RECOVER TOGETHER - ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN NICEWICZ (CEO)
(413) 281-3035
Entity
Organization
Contact information
Practice address
2457 RIDGE RD, LANSING, IL 60438-2711
(800) 683-8313
Mailing address
111 S BEDFORD ST STE 205, BURLINGTON, MA 01803-5145
(512) 439-3547
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/19/2023
Last updated
05/08/2023
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