Provider Demographics
NPI:1336770825
Name:SERENITY ROSE
Entity Type:Organization
Organization Name:SERENITY ROSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-492-0881
Mailing Address - Street 1:4981 W OGLETHORPE HWY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-5805
Mailing Address - Country:US
Mailing Address - Phone:912-877-3875
Mailing Address - Fax:912-876-5450
Practice Address - Street 1:4981 W OGLETHORPE HWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-5805
Practice Address - Country:US
Practice Address - Phone:912-877-3875
Practice Address - Fax:912-876-5450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER EXPECTATIONS ECD & LC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care