Provider Demographics
NPI:1659412955
Name:SERENITY HOUSE INC
Entity Type:Organization
Organization Name:SERENITY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-620-6616
Mailing Address - Street 1:891 SOUTH ROUTE 53
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-4220
Mailing Address - Country:US
Mailing Address - Phone:630-620-6616
Mailing Address - Fax:630-620-7924
Practice Address - Street 1:891 SOUTH ROUTE 53
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-4220
Practice Address - Country:US
Practice Address - Phone:630-620-6616
Practice Address - Fax:630-620-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
ILA06660001A324500000X
ILA06660002A324500000X
ILA06660003A324500000X
ILA06660004324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder