MEDICARE: BRANCH OF SERENITY HOME CARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1083401459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANCH OF SERENITY HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	2261 LEMA CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-1848
Country	:	US
Telephone Number	:	463-245-8806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2261 LEMA CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-1848
Country	:	US
Telephone Number	:	463-245-8806
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR/OWNER
Name	:	MRS. KYLA NICOLE SHELTON
Credential	:	LPN
Telephone Number	:	463-245-8806

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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