Provider Demographics
NPI:1609478601
Name:SERENITY SMILES HOME CARE LLC
Entity Type:Organization
Organization Name:SERENITY SMILES HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSUAAH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:718-612-1412
Mailing Address - Street 1:10105 PINESHADOW DR APT 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1149
Mailing Address - Country:US
Mailing Address - Phone:718-612-1412
Mailing Address - Fax:
Practice Address - Street 1:10105 PINESHADOW DR APT 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1149
Practice Address - Country:US
Practice Address - Phone:718-612-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care