Provider Demographics
NPI:1205532140
Name:KEYS TO SERENITY CAREGIVERS LLC
Entity type:Organization
Organization Name:KEYS TO SERENITY CAREGIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-891-6883
Mailing Address - Street 1:8036 MCGARRY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7649
Mailing Address - Country:US
Mailing Address - Phone:704-891-6883
Mailing Address - Fax:980-236-8333
Practice Address - Street 1:1546 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1955
Practice Address - Country:US
Practice Address - Phone:704-891-6883
Practice Address - Fax:980-236-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health