Provider Demographics
NPI:1821035635
Name:SERENITY HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:SERENITY HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AYOWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:773-588-4000
Mailing Address - Street 1:6640 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4516
Mailing Address - Country:US
Mailing Address - Phone:773-588-4000
Mailing Address - Fax:773-588-4005
Practice Address - Street 1:6640 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4516
Practice Address - Country:US
Practice Address - Phone:773-588-4000
Practice Address - Fax:773-588-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010494251E00000X
IL1011700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147860Medicare Oscar/Certification