MEDICARE: SERENITY HOME CARE SERVICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251G00000X	Community Based Hospice Care Agency
2	251S00000X	Community/Behavioral Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1972219673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOME CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	1235 PROVIDENCE BLVD # 1044
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7363
Country	:	US
Telephone Number	:	226-785-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 PROVIDENCE BLVD # 1044
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7363
Country	:	US
Telephone Number	:	226-785-0355
Fax Number	:	226-785-0355

Authorized Official
Title or Position	:	DIRECTOR OF HOME CARE
Name	:	SHIRIKA JONES
Credential	:
Telephone Number	:	226-785-0355

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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