Healthcare Provider Details

I. General information

NPI: 1043182389
Provider Name (Legal Business Name): ANGELS OF SERENITY HOME CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 E 53RD ST STE 221
DAVENPORT IA
52807-3620
US

IV. Provider business mailing address

4620 E 53RD ST STE 200
DAVENPORT IA
52807-3627
US

V. Phone/Fax

Practice location:
  • Phone: 563-200-1216
  • Fax: 563-265-5425
Mailing address:
  • Phone: 563-200-1216
  • Fax: 563-265-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. BROOKE BALLARD
Title or Position: ADMINSTRATOR
Credential:
Phone: 563-200-1216