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General NPI Number Information
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NPI Number | 1730009911
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Entity Type | Organization
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Legal Business Name | SERENITY HAVEN CARE NFP
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 07/17/2026
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Provider Practice Location Address
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Address Line | 160 E 145TH ST
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City | HARVEY
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State | IL
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Zip | 60426-1219
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Country | US
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Telephone | 773-993-6657
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Fax | 773-903-4774
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Provider Business Mailing Address
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Address Line | 1458 W 123RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-5768
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Country | US
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Telephone | 773-454-8514
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Fax | 773-903-4774
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | NIKKITA JOHNSON NEEALY
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Credential |
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Telephone | 773-993-6657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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