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General NPI Number Information
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NPI Number | 1871985374
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Entity Type | Organization
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Legal Business Name | EVA MAE RECOVERY HOPE INC.
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 6614 S HALSTED ST SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60621-1812
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Country | US
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Telephone | 773-952-6861
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Fax | 773-952-6868
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Provider Business Mailing Address
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Address Line | 6614 S HALSTED ST SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60621-1812
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Country | US
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Telephone | 773-952-6861
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Fax | 773-952-6868
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ADENIYI KUYE
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Credential |
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Telephone | 773-952-6861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | A-5581-0001-A
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License Number State | IL
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Taxonomy #2
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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 | A-5581-001-A
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License Number State | IL
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