Provider Demographics
NPI:1497254940
Name:SERENITY UNLIMITED, INC.
Entity Type:Organization
Organization Name:SERENITY UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-452-7142
Mailing Address - Street 1:412 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEETSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15056-1006
Mailing Address - Country:US
Mailing Address - Phone:412-452-7142
Mailing Address - Fax:
Practice Address - Street 1:412 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEETSDALE
Practice Address - State:PA
Practice Address - Zip Code:15056-1006
Practice Address - Country:US
Practice Address - Phone:412-452-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA33603601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA33603601Medicaid