Organization
RESTORING LIVES OVERCOMING ADDICTIONS
Active
Organization
RESTORING LIVES OVERCOMING ADDICTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY LLOYD COHAGEN (PRESIDENT)
(917) 334-0420
Entity
Organization
Contact information
Practice address
11187 DUNDEE RD STE 101, HUNTLEY, IL 60142-9246
(312) 675-4205
Mailing address
10469 LANCASTER ST, HUNTLEY, IL 60142-6793
(917) 334-0420
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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