Healthcare Provider Details

I. General information

NPI: 1871132480
Provider Name (Legal Business Name): SERENITY SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W 26TH CT
RIVIERA BEACH FL
33404-4123
US

IV. Provider business mailing address

1420 W 26TH CT
RIVIERA BEACH FL
33404-4123
US

V. Phone/Fax

Practice location:
  • Phone: 561-601-7773
  • Fax:
Mailing address:
  • Phone: 561-601-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: SIMONE JACKSON
Title or Position: CO-OWNER
Credential: MA
Phone: 561-601-7773