Provider Demographics
NPI:1639935281
Name:SERENITYPASS HOLISTIC HEALTH PLLC
Entity Type:Organization
Organization Name:SERENITYPASS HOLISTIC HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-577-4266
Mailing Address - Street 1:1631 ROBINETT RD
Mailing Address - Street 2:
Mailing Address - City:ODIN
Mailing Address - State:IL
Mailing Address - Zip Code:62870-2109
Mailing Address - Country:US
Mailing Address - Phone:618-322-6680
Mailing Address - Fax:
Practice Address - Street 1:1631 ROBINETT RD
Practice Address - Street 2:
Practice Address - City:ODIN
Practice Address - State:IL
Practice Address - Zip Code:62870-2109
Practice Address - Country:US
Practice Address - Phone:618-322-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty