Provider Demographics
NPI:1922694512
Name:SERENITY CARE AND SUPPORT SERVICE LLC.
Entity Type:Organization
Organization Name:SERENITY CARE AND SUPPORT SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRENEICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:330-536-1100
Mailing Address - Street 1:2383 S MAIN ST STE D104
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1190
Mailing Address - Country:US
Mailing Address - Phone:234-208-8003
Mailing Address - Fax:330-234-9466
Practice Address - Street 1:2383 S MAIN ST STE D104
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-1190
Practice Address - Country:US
Practice Address - Phone:234-208-8003
Practice Address - Fax:330-234-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health