Healthcare Provider Details

I. General information

NPI: 1831041268
Provider Name (Legal Business Name): SERENITY HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 CHEERY LN NE
COLUMBIA HEIGHTS MN
55421-1952
US

IV. Provider business mailing address

1127 CHEERY LN NE
COLUMBIA HEIGHTS MN
55421-1952
US

V. Phone/Fax

Practice location:
  • Phone: 612-384-6551
  • Fax: 952-674-4315
Mailing address:
  • Phone: 612-384-6551
  • Fax: 952-674-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. TYRONE DANIELS
Title or Position: OWNER/ MANAGER
Credential:
Phone: 612-384-6551