Serenity One Hospice and Palliative Care LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

041-372191 Issued in IL

Legal business name

SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC

Practice address

2200 S Main St Ste 212
Lombard, IL 60148-5365

Phone

(630) 953-2018

Fax

(630) 708-6077

NPI assigned

Mar 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria Rosario Montalban, RN

Title

Administrator

Phone

(708) 268-6835

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Hospice certification: CCN 141694

Legal name

SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 28, 2017

Last certification

Aug 28, 2017

Ownership / control type

Proprietary - Individual

Organization structure

LLCProprietary

Incorporated

Jan 21, 2016 in IL

Enrollment address

2200 S Main St
Ste 212
Lombard, IL 60148-5365

Listed as

Serenity One Hospice and Palliative Care LLCCCN 141694

Ownership

For-Profit

Certified

Aug 28, 2017

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Gerald Lofthouse, M.D.

  • Family Medicine Physician
  • Bolingbrook, IL
  • NPI 1972551513

  Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerald Lofthouse, M.D.

  • Family Medicine Physician
  • Bolingbrook, IL
  • NPI 1972551513
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Yoko Momoyama, MD

  • Internal Medicine Physician
  • Lombard, IL
  • NPI 1801863253

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494288000000",
    "number": "1043671829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 S MAIN ST",
            "address_2": "SUITE 212",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485334",
            "telephone_number": "630-953-2018",
            "fax_number": "630-708-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S MAIN ST STE 212",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485365",
            "telephone_number": "630-953-2018",
            "fax_number": "630-708-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY ONE HOSPICE AND PALLIATIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2017-05-09",
        "status": "A",
        "authorized_official_last_name": "MONTALBAN",
        "authorized_official_first_name": "MARIA ROSARIO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-268-6835",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "041-372191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Scott, LCP, NCC
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• Anthony Michael Sementa, D.D.S.
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• Vanessa Serna
• Dante J Serrano
• Shefali Bhatt Seth, FNP
• Garvita Sethi, PT
• Jessica Seymore, DPT

• Community Based Hospice Care Agency in Lombard, IL
• Providers in Lombard, IL by specialty
• Community Based Hospice Care Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.