Provider Demographics
NPI:1720848864
Name:SERENITY SPECIALIZED AFC INC
Entity Type:Organization
Organization Name:SERENITY SPECIALIZED AFC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-782-2804
Mailing Address - Street 1:1012 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1929
Mailing Address - Country:US
Mailing Address - Phone:313-782-2804
Mailing Address - Fax:
Practice Address - Street 1:1012 MEADOWBROOK ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1929
Practice Address - Country:US
Practice Address - Phone:313-782-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health