Provider Demographics
NPI:1871985374
Name:EVA MAE RECOVERY HOPE INC.
Entity type:Organization
Organization Name:EVA MAE RECOVERY HOPE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADENIYI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-952-6861
Mailing Address - Street 1:6614 S HALSTED ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1812
Mailing Address - Country:US
Mailing Address - Phone:773-952-6861
Mailing Address - Fax:773-952-6868
Practice Address - Street 1:6614 S HALSTED ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1812
Practice Address - Country:US
Practice Address - Phone:773-952-6861
Practice Address - Fax:773-952-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-5581-0001-A261QM2800X
ILA-5581-001-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone