Provider Demographics
NPI:1275163859
Name:HANDS OF SERENITY HOME CARE, LLC
Entity Type:Organization
Organization Name:HANDS OF SERENITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-491-4057
Mailing Address - Street 1:110 SCOTT AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7813
Mailing Address - Country:US
Mailing Address - Phone:336-870-1645
Mailing Address - Fax:336-870-1654
Practice Address - Street 1:110 SCOTT AVE STE 10
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7813
Practice Address - Country:US
Practice Address - Phone:336-870-1645
Practice Address - Fax:336-870-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care