Provider Demographics
NPI:1457160541
Name:DIVINE RECOVERY HOPE CLINIC INC. (DRHC)
Entity type:Organization
Organization Name:DIVINE RECOVERY HOPE CLINIC INC. (DRHC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TITILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADIPUPO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:708-407-0156
Mailing Address - Street 1:3936 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4389
Mailing Address - Country:US
Mailing Address - Phone:773-828-6900
Mailing Address - Fax:
Practice Address - Street 1:3936 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4389
Practice Address - Country:US
Practice Address - Phone:773-828-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone