Healthcare Provider Details

I. General information

NPI: 1790656627
Provider Name (Legal Business Name): HOPE AND DIVINE PURPOSE TRANSITIONAL LIVING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CLEMENT ST
JOLIET IL
60435-6103
US

IV. Provider business mailing address

103 GIRARD BLVD
JOLIET IL
60433-3105
US

V. Phone/Fax

Practice location:
  • Phone: 708-537-3369
  • Fax:
Mailing address:
  • Phone: 708-537-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ISRAEIO HOLLOWAY
Title or Position: FOUNDER/CEO
Credential: MA, QMHP
Phone: 708-537-3369