Healthcare Provider Details

I. General information

NPI: 1720428261
Provider Name (Legal Business Name): SERENITY SQUARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
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: 337-266-5892
  • Fax: 337-266-5893
Mailing address:
  • Phone: 337-266-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC0007356
License Number StateLA

VIII. Authorized Official

Name: ROBERT A CAILLIER
Title or Position: MANAGER
Credential:
Phone: 337-266-5892