MEDICARE: SERENITY HOUSING 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871354407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOUSING SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	1367 WILLOW ST APT 436
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2591
Country	:	US
Telephone Number	:	608-239-8704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1367 WILLOW ST APT 436
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2591
Country	:	US
Telephone Number	:	608-239-8704
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NORA HAJI-JAMA
Credential	:
Telephone Number	:	608-239-8704

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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