Servant of Peace LLC
Organization Active NPI Clinical Social Worker · Evergreen PK, IL
NPI 1104702133 · NPPES record last updated Aug 14, 2025
Key facts
- NPI
- 1104702133
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- SERVANT OF PEACE LLC
- Practice address
- 9730 S Western Ave Ste 306
Evergreen PK, IL 60805-2766 - Phone
- (773) 332-6664
- NPI assigned
- Aug 14, 2025
- Organization subpart
- No
Authorized official
- Name
- Aidarina Basarudin-Pigott
- Title
- Owner
- Phone
- (773) 332-6664
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260219002654 | IL | Part B Supplier - Clinic/Group Practice | 2062902380 |
Receives reassigned benefits from 1 practitioner Practice locations: Evergreen Park, IL |
National Provider Directory
Locations
9730 S Western Ave
Ste 306
Evergreen Pk, IL 60805
Phone (773) 332-6664
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
9730 S Western Ave Ste 306
Evergreen PK, IL 60805-2766
Mailing address
14012 S Green Bay Ave
Burnham, IL 60633-1616
Phone (773) 332-6664
Other providers in Evergreen PK, IL
- Naomi Knox
- Chiquita Lee
- N'Courage Counseling and Consultation Services, PLLC
- Deborah Olubukunola Oyelowo
- Antoinette Sallamme
- Tamika St. Clair
- Unicolive Home Healthcare Services Inc
All providers in Evergreen PK, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.