Healthcare Provider Details

I. General information

NPI: 1700303591
Provider Name (Legal Business Name): SERENITY HOME CARE & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LAKE DEBRA DRIVE APT 112
ORLANDO FL
32835
US

IV. Provider business mailing address

P.O. BOX 1603
ORLANDO FL
34786
US

V. Phone/Fax

Practice location:
  • Phone: 740-971-9901
  • Fax:
Mailing address:
  • Phone: 802-328-1970
  • Fax: 407-601-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA348786
License Number StateFL

VIII. Authorized Official

Name: MS. GEMMA P. VEGA
Title or Position: CEO/DIRECTOR/FINANCIAL OFFICER
Credential: CNA
Phone: 740-971-9901