Provider Demographics
NPI:1942805825
Name:TIME OF SERENITY IN HOME SERVICES, LLC
Entity Type:Organization
Organization Name:TIME OF SERENITY IN HOME SERVICES, LLC
Other - Org Name:TIME OF SERENITY IHS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-409-2996
Mailing Address - Street 1:5842 MACKLIND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3569
Mailing Address - Country:US
Mailing Address - Phone:314-409-2996
Mailing Address - Fax:
Practice Address - Street 1:5842 MACKLIND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3569
Practice Address - Country:US
Practice Address - Phone:314-409-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT1019Medicaid