Healthcare Provider Details

I. General information

NPI: 1902521552
Provider Name (Legal Business Name): SERENITY HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 STATE ROAD 23 STE 6
GRANGER IN
46530-5632
US

IV. Provider business mailing address

1710 LEER DR STE A
ELKHART IN
46514-5446
US

V. Phone/Fax

Practice location:
  • Phone: 574-327-2357
  • Fax: 574-235-6991
Mailing address:
  • Phone: 574-327-2357
  • Fax: 574-235-6991

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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ABDUL M MALIK
Title or Position: MEMBER/ MANAGER
Credential:
Phone: 574-296-6556