Provider Demographics
NPI:1598528689
Name:SERENE VILLAGE HOME CARE LLC
Entity Type:Organization
Organization Name:SERENE VILLAGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERIA
Authorized Official - Middle Name:KAI
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-557-6174
Mailing Address - Street 1:579 SIMONTON OAK LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3525
Mailing Address - Country:US
Mailing Address - Phone:678-557-6174
Mailing Address - Fax:
Practice Address - Street 1:579 SIMONTON OAK LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3525
Practice Address - Country:US
Practice Address - Phone:678-557-6174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care