Healthcare Provider Details

I. General information

NPI: 1649821240
Provider Name (Legal Business Name): SERENITY PERSONAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W GAINES ST
MONTICELLO AR
71655-4638
US

IV. Provider business mailing address

PO BOX 752
MONTICELLO AR
71657-0752
US

V. Phone/Fax

Practice location:
  • Phone: 870-224-8051
  • Fax:
Mailing address:
  • Phone: 870-723-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DENISE YVONNE COURTNEY
Title or Position: MEMBER
Credential:
Phone: 870-723-9049