Provider Demographics
NPI:1760909923
Name:SERENE HEALTHCARE SERVICES, LLC.
Entity Type:Organization
Organization Name:SERENE HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:NKAFU
Authorized Official - Last Name:FOMENKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-248-6394
Mailing Address - Street 1:4613 CUTLASS DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4613 CUTLASS DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2515
Practice Address - Country:US
Practice Address - Phone:937-248-6394
Practice Address - Fax:937-248-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health