Provider Demographics
NPI:1104219120
Name:SERENITY HOME CARE, LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-235-1403
Mailing Address - Street 1:8151 33RD AVE S
Mailing Address - Street 2:609E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4518
Mailing Address - Country:US
Mailing Address - Phone:651-235-1403
Mailing Address - Fax:
Practice Address - Street 1:316 CENTRAL AVE
Practice Address - Street 2:SUITE 2 LL
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021
Practice Address - Country:US
Practice Address - Phone:507-201-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health