Provider Demographics
NPI:1346508819
Name:SERENITY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SERENITY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-230-0947
Mailing Address - Street 1:510 CHURCH ST
Mailing Address - Street 2:510 CHURCH STREET
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-2802
Mailing Address - Country:US
Mailing Address - Phone:662-230-0947
Mailing Address - Fax:
Practice Address - Street 1:510 CHURCH ST
Practice Address - Street 2:510 CHURCH STREET
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2802
Practice Address - Country:US
Practice Address - Phone:662-230-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies