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General NPI Number Information
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NPI Number | 1265979694
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Entity Type | Organization
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Legal Business Name | RENEWED HOPE COMMUNITY SERVICES
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 618 E 71ST ST
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City | CHICAGO
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State | IL
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Zip | 60619-1244
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Country | US
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Telephone | 773-855-9896
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Fax |
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Provider Business Mailing Address
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Address Line | 618 E 71ST ST
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City | CHICAGO
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State | IL
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Zip | 60619-1244
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Country | US
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Telephone | 773-855-9896
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATION
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Name | MR. ADENIYI KUYE
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Credential |
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Telephone | 773-783-3579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | IL-10136-M
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License Number State | IL
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