Provider Demographics
NPI:1083366843
Name:SERENITY PERSONAL CARE LLC
Entity Type:Organization
Organization Name:SERENITY PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-368-6880
Mailing Address - Street 1:3311 S RAINBOW BLVD STE 131
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6208
Mailing Address - Country:US
Mailing Address - Phone:702-368-6880
Mailing Address - Fax:702-213-9042
Practice Address - Street 1:3311 S RAINBOW BLVD STE 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6208
Practice Address - Country:US
Practice Address - Phone:702-368-6880
Practice Address - Fax:702-213-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care