Provider Demographics
NPI:1912610411
Name:NULIFE RECOVERY ILLINOIS, INC
Entity Type:Organization
Organization Name:NULIFE RECOVERY ILLINOIS, INC
Other - Org Name:NULIFE RECOVERY ILLINOIS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-372-6480
Mailing Address - Street 1:33 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1707
Mailing Address - Country:US
Mailing Address - Phone:845-372-6480
Mailing Address - Fax:
Practice Address - Street 1:1400 E LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8217
Practice Address - Country:US
Practice Address - Phone:806-230-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)