Provider Demographics
NPI:1801657341
Name:SERENITY INNOVATIVE CARE AGENCY
Entity type:Organization
Organization Name:SERENITY INNOVATIVE CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JEANIA
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-603-7741
Mailing Address - Street 1:305 S WASHINGTON HWY STE G7
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2257
Mailing Address - Country:US
Mailing Address - Phone:804-250-9426
Mailing Address - Fax:
Practice Address - Street 1:3108 N PARHAM RD STE 602A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4417
Practice Address - Country:US
Practice Address - Phone:804-250-9426
Practice Address - Fax:804-446-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty