Provider Demographics
NPI:1942182662
Name:REVIVE TREATMENT CENTER - LAKE ZURICH LLC
Entity type:Organization
Organization Name:REVIVE TREATMENT CENTER - LAKE ZURICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-220-8884
Mailing Address - Street 1:365 SURRYSE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2679
Mailing Address - Country:US
Mailing Address - Phone:847-320-1133
Mailing Address - Fax:312-757-6869
Practice Address - Street 1:365 SURRYSE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2679
Practice Address - Country:US
Practice Address - Phone:847-320-1133
Practice Address - Fax:312-757-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder