Healthcare Provider Details

I. General information

NPI: 1326748880
Provider Name (Legal Business Name): SERENE CARE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10806 REISTERSTOWN RD STE 1F
OWINGS MILLS MD
21117-4602
US

IV. Provider business mailing address

10806 REISTERSTOWN RD STE 1F
OWINGS MILLS MD
21117-4602
US

V. Phone/Fax

Practice location:
  • Phone: 410-204-2866
  • Fax:
Mailing address:
  • Phone: 410-204-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STECY OLA
Title or Position: PRESIDENT
Credential: CRNP, FNP, PMH
Phone: 410-204-2866