Healthcare Provider Details

I. General information

NPI: 1528863057
Provider Name (Legal Business Name): SERENITY HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 S US HIGHWAY 1
PORT SAINT LUCIE FL
34952-3306
US

IV. Provider business mailing address

8442 S US HIGHWAY 1
PORT SAINT LUCIE FL
34952-3306
US

V. Phone/Fax

Practice location:
  • Phone: 772-252-6543
  • Fax: 772-266-2835
Mailing address:
  • Phone: 772-252-6543
  • Fax: 772-266-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JASMINE NOEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 772-867-2278