Healthcare Provider Details

I. General information

NPI: 1104718139
Provider Name (Legal Business Name): SERENITY FIRST HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 ERION CT
BOWIE MD
20721-2843
US

IV. Provider business mailing address

10016 ERION CT
BOWIE MD
20721-2843
US

V. Phone/Fax

Practice location:
  • Phone: 240-504-6293
  • Fax:
Mailing address:
  • Phone: 240-504-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GIBSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-604-6293