Provider Demographics
NPI:1518747518
Name:SERENITY HOME CARE SPECIALTY ,LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE SPECIALTY ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-282-0236
Mailing Address - Street 1:7131 PEPPERMILL LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3441
Mailing Address - Country:US
Mailing Address - Phone:901-282-0236
Mailing Address - Fax:
Practice Address - Street 1:7131 PEPPERMILL LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-3441
Practice Address - Country:US
Practice Address - Phone:901-282-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities