Provider Demographics
NPI:1174024210
Name:SERENITY HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KERLLANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCCEUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-738-8688
Mailing Address - Street 1:734 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3985
Mailing Address - Country:US
Mailing Address - Phone:239-738-8688
Mailing Address - Fax:
Practice Address - Street 1:734 ROBIN HOOD DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3985
Practice Address - Country:US
Practice Address - Phone:239-738-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 314000000X
GA089-R-1894253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility