| No | |
|
Serenity On Wheels, Inc. 630 Columbus Street Ste # 214 Ottawa IL 61350 | |
| (815) 431-8206 | |
| Not Available |
| Full Name | No |
|---|---|
| Speciality | Counselor - Professional |
| Location | Serenity On Wheels, Inc. 630 Columbus Street, Ottawa, Illinois |
| Authorized Official Name and Position | Kathleen Shea (COUNSELOR) |
| Authorized Official Contact | 8154318206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| No 630 Columbus Street Ste # 214 Ottawa IL 61350 Ph: (815) 431-8206 | No Serenity On Wheels, Inc. 630 Columbus Street Ste # 214 Ottawa IL 61350 Ph: (815) 431-8206 |
| NPI Number | 1154538510 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154538510 | NPI | - | NPPES |
| 6878 | Other | IL | CADC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 6878 (Illinois) | Primary |
| 101YP2500X | Counselor - Professional | (Illinois) | Primary |
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