Provider Demographics
NPI:1881455293
Name:1630 SERENE CARE SOLUTIONS
Entity type:Organization
Organization Name:1630 SERENE CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-441-7983
Mailing Address - Street 1:2662 WILLOW GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3659
Mailing Address - Country:US
Mailing Address - Phone:317-441-7983
Mailing Address - Fax:
Practice Address - Street 1:2662 WILLOW GLEN CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3659
Practice Address - Country:US
Practice Address - Phone:317-441-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care