Provider Demographics
NPI:1013218783
Name:SERENITY HOMECARE, LLC
Entity Type:Organization
Organization Name:SERENITY HOMECARE, LLC
Other - Org Name:SERENITY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDET/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-717-4501
Mailing Address - Street 1:2809 W GODMAN AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4477
Mailing Address - Country:US
Mailing Address - Phone:765-212-2156
Mailing Address - Fax:765-212-2713
Practice Address - Street 1:2809 W GODMAN AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4477
Practice Address - Country:US
Practice Address - Phone:765-212-2156
Practice Address - Fax:765-212-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012415-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1013218783Medicaid