Provider Demographics
NPI:1669128609
Name:SERENITY HOME CARE LLC
Entity type:Organization
Organization Name:SERENITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-688-9942
Mailing Address - Street 1:4451 W ST ANNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6232
Mailing Address - Country:US
Mailing Address - Phone:858-413-5494
Mailing Address - Fax:
Practice Address - Street 1:6519 W BRANHAM LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2723
Practice Address - Country:US
Practice Address - Phone:858-413-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities