Provider Demographics
NPI:1184448474
Name:SERENITY HOME SUPPORT
Entity type:Organization
Organization Name:SERENITY HOME SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CISLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-848-0738
Mailing Address - Street 1:5304 TRUMPET VINE WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6266
Mailing Address - Country:US
Mailing Address - Phone:518-848-0738
Mailing Address - Fax:
Practice Address - Street 1:5215 MARKET ST # A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3433
Practice Address - Country:US
Practice Address - Phone:518-848-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care