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General NPI Number Information
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NPI Number | 1043671829
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Entity Type | Organization
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Legal Business Name | SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST STE 212
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City | LOMBARD
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State | IL
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Zip | 60148-5365
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Country | US
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Telephone | 630-953-2018
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Fax | 630-708-6077
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Provider Business Mailing Address
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Address Line | 2200 S MAIN ST SUITE 212
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 630-953-2018
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Fax | 630-708-6077
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIA ROSARIO MONTALBAN
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Credential | RN
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Telephone | 708-268-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 041-372191
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License Number State | IL
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