Provider Demographics
NPI:1093909160
Name:SERENITY NURSING STAFF
Entity Type:Organization
Organization Name:SERENITY NURSING STAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAQQ
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NURSE
Authorized Official - Phone:203-868-7992
Mailing Address - Street 1:96 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1204
Mailing Address - Country:US
Mailing Address - Phone:203-389-6296
Mailing Address - Fax:203-389-1226
Practice Address - Street 1:681 DIXWELL AVENUE
Practice Address - Street 2:#3
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-389-6296
Practice Address - Fax:203-389-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03462897251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care