Provider Demographics
NPI:1437302056
Name:SERENITY HOME CARE SERVICES, P.C.
Entity type:Organization
Organization Name:SERENITY HOME CARE SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EMEKA
Authorized Official - Last Name:AZUBOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-865-0598
Mailing Address - Street 1:17800 WOODWARD AVENUE
Mailing Address - Street 2:SUITE 100 C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2259
Mailing Address - Country:US
Mailing Address - Phone:313-865-0598
Mailing Address - Fax:313-865-4723
Practice Address - Street 1:17800 WOODWARD AVENUE
Practice Address - Street 2:SUITE 100 C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2259
Practice Address - Country:US
Practice Address - Phone:313-865-0598
Practice Address - Fax:313-865-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health