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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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