Provider Demographics
NPI:1609385087
Name:SERENITY ONE HOME HEALTHCARE PLLC
Entity Type:Organization
Organization Name:SERENITY ONE HOME HEALTHCARE PLLC
Other - Org Name:SERENITY ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH CARE LIC
Authorized Official - Phone:901-801-7621
Mailing Address - Street 1:2555 CALVERT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-1627
Mailing Address - Country:US
Mailing Address - Phone:901-801-7621
Mailing Address - Fax:
Practice Address - Street 1:2555 CALVERT AVE APT 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-1627
Practice Address - Country:US
Practice Address - Phone:901-801-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000020581251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health