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General NPI Number Information
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NPI Number | 1457160541
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Entity Type | Organization
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Legal Business Name | DIVINE RECOVERY HOPE CLINIC INC. (DRHC)
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 3936 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60624-4389
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Country | US
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Telephone | 773-828-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60624-4389
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Country | US
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Telephone | 773-828-6900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TITILAYO OLADIPUPO
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Credential | PHARMACIST
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Telephone | 708-407-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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