Provider Demographics
NPI:1790549384
Name:SERENITY MEDICAL HOUSE CALLS LLC
Entity type:Organization
Organization Name:SERENITY MEDICAL HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MESHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-8488
Mailing Address - Street 1:7231 CHAD CT
Mailing Address - Street 2:
Mailing Address - City:OKAHUMPKA
Mailing Address - State:FL
Mailing Address - Zip Code:34762-6647
Mailing Address - Country:US
Mailing Address - Phone:856-669-8488
Mailing Address - Fax:352-321-4247
Practice Address - Street 1:7231 CHAD CT
Practice Address - Street 2:
Practice Address - City:OKAHUMPKA
Practice Address - State:FL
Practice Address - Zip Code:34762-6647
Practice Address - Country:US
Practice Address - Phone:856-669-8488
Practice Address - Fax:352-321-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty