- Enrollment id
- O20161214000714
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1043671829
- Multiple npi flag
- N
- Ccn
- 141694
- Associate id
- 8820378623
- Organization name
- SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC
- Incorporation date
- 2016-01-21
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2200 S MAIN ST
- Address line 2
- STE 212
- City
- LOMBARD
- State
- IL
- Zip code
- 601485365