Provider Demographics
NPI:1841553435
Name:SERENITY HOME CARE AGENCY
Entity type:Organization
Organization Name:SERENITY HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:SIDBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-340-2254
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MAPLE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28454-0128
Mailing Address - Country:US
Mailing Address - Phone:910-340-2254
Mailing Address - Fax:
Practice Address - Street 1:12 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4924
Practice Address - Country:US
Practice Address - Phone:910-340-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4527253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care