Healthcare Provider Details

I. General information

NPI: 1144804220
Provider Name (Legal Business Name): SERENITY HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/08/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 COBBLESTONE LN
LONG GROVE IL
60047-5164
US

IV. Provider business mailing address

6601 COBBLESTONE LN
LONG GROVE IL
60047-5164
US

V. Phone/Fax

Practice location:
  • Phone: 630-440-7292
  • Fax:
Mailing address:
  • Phone: 630-440-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NOMAN KABA
Title or Position: MANAGER
Credential:
Phone: 630-440-7292