Provider Demographics
NPI:1851078067
Name:SERENITY HOME CARE OF ATLANTA
Entity Type:Organization
Organization Name:SERENITY HOME CARE OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOORE GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPAR
Authorized Official - Phone:404-437-5039
Mailing Address - Street 1:3755 BUSBY MILL CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2059
Mailing Address - Country:US
Mailing Address - Phone:404-437-5039
Mailing Address - Fax:
Practice Address - Street 1:3755 BUSBY MILL CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2059
Practice Address - Country:US
Practice Address - Phone:404-437-5039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home