Provider Demographics
NPI:1619113974
Name:RECOVERY OPTIONS OF CHAMPAIGN COUNTY LTD
Entity Type:Organization
Organization Name:RECOVERY OPTIONS OF CHAMPAIGN COUNTY LTD
Other - Org Name:RECOVERY OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-344-2740
Mailing Address - Street 1:2917 B1 CROSSING COURT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:217-344-2740
Mailing Address - Fax:217-344-2819
Practice Address - Street 1:2917 B1 CROSSING COURT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-344-2740
Practice Address - Fax:217-344-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083081261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083081OtherSTATE LICENSE NUMBER