Healthcare Provider Details

I. General information

NPI: 1780015321
Provider Name (Legal Business Name): SERENITY SLEEP CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WOODYARD RD SUITE C
CLINTON MD
20735-4264
US

IV. Provider business mailing address

9001 WOODYARD RD SUITE C
CLINTON MD
20735-4264
US

V. Phone/Fax

Practice location:
  • Phone: 410-885-4411
  • Fax: 410-885-4409
Mailing address:
  • Phone: 410-885-4411
  • Fax: 410-885-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANNIE AHN
Title or Position: MANAGING PARTNER
Credential:
Phone: 410-885-4411