Healthcare Provider Details

I. General information

NPI: 1457160541
Provider Name (Legal Business Name): DIVINE RECOVERY HOPE CLINIC INC. (DRHC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 W ROOSEVELT RD
CHICAGO IL
60624-4389
US

IV. Provider business mailing address

3936 W ROOSEVELT RD
CHICAGO IL
60624-4389
US

V. Phone/Fax

Practice location:
  • Phone: 773-828-6900
  • Fax:
Mailing address:
  • Phone: 773-828-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TITILAYO OLADIPUPO
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 708-407-0156