Provider Demographics
NPI:1770061822
Name:RESTORING LIVES OVERCOMING ADDICTIONS
Entity type:Organization
Organization Name:RESTORING LIVES OVERCOMING ADDICTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:COHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-334-0420
Mailing Address - Street 1:10469 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6793
Mailing Address - Country:US
Mailing Address - Phone:917-334-0420
Mailing Address - Fax:
Practice Address - Street 1:11187 DUNDEE RD STE 101
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9246
Practice Address - Country:US
Practice Address - Phone:312-675-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility