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General NPI Number Information
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NPI Number | 1104702133
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Entity Type | Organization
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Legal Business Name | SERVANT OF PEACE LLC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 9730 S WESTERN AVE STE 306
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City | EVERGREEN PK
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State | IL
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Zip | 60805-2766
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Country | US
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Telephone | 773-332-6664
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Fax |
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Provider Business Mailing Address
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Address Line | 14012 S GREEN BAY AVE
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City | BURNHAM
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State | IL
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Zip | 60633-1616
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Country | US
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Telephone | 773-332-6664
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AIDARINA BASARUDIN-PIGOTT
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Credential |
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Telephone | 773-332-6664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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