Provider Demographics
NPI:1831434828
Name:SWEET SERENITY HOMECARE LLC
Entity type:Organization
Organization Name:SWEET SERENITY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-678-8986
Mailing Address - Street 1:733 W. MARKET ST. SUITE B4
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303
Mailing Address - Country:US
Mailing Address - Phone:234-678-8986
Mailing Address - Fax:
Practice Address - Street 1:1485 S. HAWKINS AVE SUITE 130
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-400-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3111199Medicaid