Healthcare Provider Details

I. General information

NPI: 1336770825
Provider Name (Legal Business Name): SERENITY ROSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4981 W OGLETHORPE HWY
HINESVILLE GA
31313-5805
US

IV. Provider business mailing address

4981 W OGLETHORPE HWY
HINESVILLE GA
31313-5805
US

V. Phone/Fax

Practice location:
  • Phone: 912-877-3875
  • Fax: 912-876-5450
Mailing address:
  • Phone: 912-877-3875
  • Fax: 912-876-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BELVA DUNCAN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 912-492-0881