MEDICARE: SERENITY HOME CARE SOLUTIONS, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25-016706-1	OTHER	IN	PERSONAL SERVICES AGENCY LICENSE

General Provider Information

NPI Number	:	1669259289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOME CARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	5226 MILHOUSE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 MILHOUSE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-4214
Country	:	US
Telephone Number	:	317-464-7208
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIMMY ALEXANDER III
Credential	:
Telephone Number	:	317-464-0286

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	04/16/2025

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