Healthcare Provider Details

I. General information

NPI: 1962959916
Provider Name (Legal Business Name): SERENE HOME CARE OF CLEARWATER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GULF TO BAY BLVD SUITE 216
CLEARWATER FL
33759-4321
US

IV. Provider business mailing address

3802 EHRLICH RD STE. 309-A
TAMPA FL
33624-2378
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-0268
  • Fax: 813-252-6941
Mailing address:
  • Phone: 813-374-0268
  • Fax: 813-252-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNY SEGARRA
Title or Position: MANAGER
Credential:
Phone: 813-210-0982