Provider Demographics
NPI:1972219673
Name:SERENITY HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:SERENITY HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME CARE
Authorized Official - Prefix:
Authorized Official - First Name:SHIRIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:226-785-0355
Mailing Address - Street 1:1235 PROVIDENCE BLVD # 1044
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7363
Mailing Address - Country:US
Mailing Address - Phone:226-785-0355
Mailing Address - Fax:
Practice Address - Street 1:1235 PROVIDENCE BLVD # 1044
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7363
Practice Address - Country:US
Practice Address - Phone:226-785-0355
Practice Address - Fax:226-785-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care