Provider Demographics
NPI:1114317906
Name:SERENITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:SERENITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOLEVER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:614-202-1885
Mailing Address - Street 1:10 E SCHROCK RD # 228
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2915
Mailing Address - Country:US
Mailing Address - Phone:614-202-1885
Mailing Address - Fax:855-740-2025
Practice Address - Street 1:10 E SCHROCK RD # 228
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2915
Practice Address - Country:US
Practice Address - Phone:614-202-1885
Practice Address - Fax:855-740-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care