Provider Demographics
NPI:1104702133
Name:SERVANT OF PEACE LLC
Entity type:Organization
Organization Name:SERVANT OF PEACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIDARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASARUDIN-PIGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-332-6664
Mailing Address - Street 1:14012 S GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-1616
Mailing Address - Country:US
Mailing Address - Phone:773-332-6664
Mailing Address - Fax:
Practice Address - Street 1:9730 S WESTERN AVE STE 306
Practice Address - Street 2:
Practice Address - City:EVERGREEN PK
Practice Address - State:IL
Practice Address - Zip Code:60805-2766
Practice Address - Country:US
Practice Address - Phone:773-332-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty