Healthcare Provider Details

I. General information

NPI: 1730009911
Provider Name (Legal Business Name): SERENITY HAVEN CARE NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 145TH ST
HARVEY IL
60426-1219
US

IV. Provider business mailing address

1458 W 123RD ST
CHICAGO IL
60643-5768
US

V. Phone/Fax

Practice location:
  • Phone: 773-993-6657
  • Fax: 773-903-4774
Mailing address:
  • Phone: 773-454-8514
  • Fax: 773-903-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NIKKITA JOHNSON NEEALY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-993-6657