Provider Demographics
NPI:1912414368
Name:SERENITY HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:SERENITY HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:LANIECE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-904-9563
Mailing Address - Street 1:3050 W 114TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-1847
Mailing Address - Country:US
Mailing Address - Phone:216-904-9563
Mailing Address - Fax:
Practice Address - Street 1:3050 W 114TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-1847
Practice Address - Country:US
Practice Address - Phone:216-904-9563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health