Provider Demographics
NPI:1396618328
Name:SERENITY HEARTS ENTERPRISE LLC
Entity type:Organization
Organization Name:SERENITY HEARTS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE AIDE 1
Authorized Official - Phone:704-685-2081
Mailing Address - Street 1:10927 DAVID TAYLOR DRIVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:877-317-6114
Mailing Address - Fax:
Practice Address - Street 1:4815 WILLIAM CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-0209
Practice Address - Country:US
Practice Address - Phone:704-685-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health