Provider Demographics
NPI:1912310335
Name:ANGELS OF SERENITY HOME CARE LLC
Entity Type:Organization
Organization Name:ANGELS OF SERENITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TEKELA
Authorized Official - Middle Name:SHANTA
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-417-9291
Mailing Address - Street 1:4038B CALHOUN MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9068
Mailing Address - Country:US
Mailing Address - Phone:864-417-9291
Mailing Address - Fax:
Practice Address - Street 1:4038B CALHOUN MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-9068
Practice Address - Country:US
Practice Address - Phone:864-417-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home