Healthcare Provider Details

I. General information

NPI: 1689146961
Provider Name (Legal Business Name): SERENITY CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 W 31ST ST
SAINT LOUIS PARK MN
55426-2968
US

IV. Provider business mailing address

9020 W 31ST ST
SAINT LOUIS PARK MN
55426-2968
US

V. Phone/Fax

Practice location:
  • Phone: 952-652-3661
  • Fax: 952-513-2027
Mailing address:
  • Phone: 952-652-3661
  • Fax: 952-513-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KHALID GABEYRE
Title or Position: MANAGMENT
Credential:
Phone: 952-652-3661