Provider Demographics
NPI:1689146961
Name:SERENITY CARE HOME INC
Entity Type:Organization
Organization Name:SERENITY CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGMENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:GABEYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-652-3661
Mailing Address - Street 1:9020 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2968
Mailing Address - Country:US
Mailing Address - Phone:952-652-3661
Mailing Address - Fax:952-513-2027
Practice Address - Street 1:9020 W 31ST ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2968
Practice Address - Country:US
Practice Address - Phone:952-652-3661
Practice Address - Fax:952-513-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility