Provider Demographics
NPI:1043671829
Name:SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALBAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-268-6835
Mailing Address - Street 1:2200 S MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5334
Mailing Address - Country:US
Mailing Address - Phone:630-953-2018
Mailing Address - Fax:630-708-6077
Practice Address - Street 1:2200 S MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5365
Practice Address - Country:US
Practice Address - Phone:630-953-2018
Practice Address - Fax:630-708-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-372191251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based