Provider Demographics
NPI:1891229779
Name:SERENITY IN HOME CARE,LLC
Entity Type:Organization
Organization Name:SERENITY IN HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-769-8401
Mailing Address - Street 1:1409 WASHINGTON AVE STE 517
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1901
Mailing Address - Country:US
Mailing Address - Phone:314-696-8960
Mailing Address - Fax:314-696-8960
Practice Address - Street 1:1409 WASHINGTON AVE STE 517
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1901
Practice Address - Country:US
Practice Address - Phone:314-696-8960
Practice Address - Fax:314-696-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC9800049253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care