Provider Demographics
NPI:1821717760
Name:SERENITY SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SERENITY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEBRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-MERIDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-222-6613
Mailing Address - Street 1:404 S PARLIAMENT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6302
Mailing Address - Country:US
Mailing Address - Phone:757-222-6613
Mailing Address - Fax:
Practice Address - Street 1:404 S PARLIAMENT DR STE 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6302
Practice Address - Country:US
Practice Address - Phone:757-222-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care