| Organization Name: | SERENITY HAVEN ADULT DAY CARE INC |
| NPI Number: | 1912149626 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NIKKITA C JOHNSON- NEEALY (OWNER/NURSE) |
| Mailing Address: | 1109 E 156th St Dolton |
| State: | IL US |
| Postal Code: | 604192777 |
| Phone Number: | 7084763795 |
| Fax Number: | 7738210720 |
| NPI Enumeration Date: | 03/26/2009 |
| NPI Last Update Date: | 05/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 164W00000X |
| License Number: | 043.087417 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Practical Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |