Provider Demographics
NPI: | 1760724066 |
---|---|
Name: | SERENITY HOME HEALTH SERVICES |
Entity Type: | Organization |
Organization Name: | SERENITY HOME HEALTH SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EVELYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VARGAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 908-925-1990 |
Mailing Address - Street 1: | 11 ANDERSON CT |
Mailing Address - Street 2: | |
Mailing Address - City: | SAYREVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08872-1000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-387-0240 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 218 N WOOD AVE |
Practice Address - Street 2: | |
Practice Address - City: | LINDEN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07036-4217 |
Practice Address - Country: | US |
Practice Address - Phone: | 908-925-1990 |
Practice Address - Fax: | 908-925-1968 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-25 |
Last Update Date: | 2013-03-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 1578767190 | Medicaid |