Provider Demographics
NPI:1376980516
Name:DEVINE SERENITY HOME CARE
Entity Type:Organization
Organization Name:DEVINE SERENITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-232-1974
Mailing Address - Street 1:1213 MISTY MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6304
Mailing Address - Country:US
Mailing Address - Phone:678-232-1974
Mailing Address - Fax:678-489-4032
Practice Address - Street 1:1213 MISTY MEADOWS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6304
Practice Address - Country:US
Practice Address - Phone:678-232-1974
Practice Address - Fax:678-489-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-1057251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care