Healthcare Provider Details

I. General information

NPI: 1740464841
Provider Name (Legal Business Name): SERENITY HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 W MANCHESTER BLVD
INGLEWOOD CA
90301
US

IV. Provider business mailing address

414 W 99TH ST
LOS ANGELES CA
90003-3919
US

V. Phone/Fax

Practice location:
  • Phone: 323-440-8033
  • Fax:
Mailing address:
  • Phone: 323-440-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. WENDELL CHEVELL WALKER
Title or Position: SOLE OWNER
Credential:
Phone: 323-440-8033