Provider Demographics
NPI:1861820391
Name:SERENITY HOME CARE, LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-318-1591
Mailing Address - Street 1:9510 IRON BRIDGE RD
Mailing Address - Street 2:210
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6400
Mailing Address - Country:US
Mailing Address - Phone:804-318-1591
Mailing Address - Fax:
Practice Address - Street 1:9510 IRON BRIDGE RD
Practice Address - Street 2:210
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6400
Practice Address - Country:US
Practice Address - Phone:804-318-1591
Practice Address - Fax:866-597-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1276591251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health