Healthcare Provider Details

I. General information

NPI: 1659412955
Provider Name (Legal Business Name): SERENITY HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 SOUTH ROUTE 53
ADDISON IL
60101-4220
US

IV. Provider business mailing address

891 SOUTH ROUTE 53
ADDISON IL
60101-4220
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-6616
  • Fax: 630-620-7924
Mailing address:
  • Phone: 630-620-6616
  • Fax: 630-620-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA06660001A
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA06660002A
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA06660003A
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA06660004
License Number StateIL

VIII. Authorized Official

Name: GINA RYBINSKI
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 630-620-6616