Healthcare Provider Details

I. General information

NPI: 1720943160
Provider Name (Legal Business Name): SERENITY SQUARE OF BAYOU CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 SURREY ST
LAFAYETTE LA
70501-7617
US

IV. Provider business mailing address

1353 SURREY ST
LAFAYETTE LA
70501-7617
US

V. Phone/Fax

Practice location:
  • Phone: 337-704-7777
  • Fax:
Mailing address:
  • Phone: 337-704-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A CAILLIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 337-704-7777