Provider Demographics
NPI:1891565081
Name:SERENITY TRANSPORTATION INC
Entity Type:Organization
Organization Name:SERENITY TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKISSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-354-7664
Mailing Address - Street 1:3651 LINDELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1200
Mailing Address - Country:US
Mailing Address - Phone:404-354-7664
Mailing Address - Fax:
Practice Address - Street 1:2473 GILPIN AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:404-354-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)