Provider Demographics
NPI:1831819564
Name:SERENE LOVING CARE AT HOME LLC
Entity type:Organization
Organization Name:SERENE LOVING CARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSWELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-530-7705
Mailing Address - Street 1:2113 CITRUS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3018
Mailing Address - Country:US
Mailing Address - Phone:352-561-8760
Mailing Address - Fax:352-608-9811
Practice Address - Street 1:2113 CITRUS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3018
Practice Address - Country:US
Practice Address - Phone:352-561-8760
Practice Address - Fax:352-608-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116965300Medicaid