Provider Demographics
NPI:1114662772
Name:SERENITY QUALITY HOME CARE LLC
Entity Type:Organization
Organization Name:SERENITY QUALITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ITSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-449-2754
Mailing Address - Street 1:12131 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-1596
Mailing Address - Country:US
Mailing Address - Phone:810-449-2754
Mailing Address - Fax:
Practice Address - Street 1:12131 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-1596
Practice Address - Country:US
Practice Address - Phone:810-407-8333
Practice Address - Fax:810-407-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health