Healthcare Provider Details

I. General information

NPI: 1720316433
Provider Name (Legal Business Name): SERENITY HOME HEALTH CARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SELBY AVE SUITE# M
SAINT PAUL MN
55102-4508
US

IV. Provider business mailing address

400 SELBY AVE SUITE# M
SAINT PAUL MN
55102-4508
US

V. Phone/Fax

Practice location:
  • Phone: 651-493-4536
  • Fax: 651-493-4868
Mailing address:
  • Phone: 651-493-4536
  • Fax: 651-493-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number345918
License Number StateMN

VIII. Authorized Official

Name: MOHAMED T. ALBERT
Title or Position: PRESIDENT/GENERAL MANAGER
Credential:
Phone: 952-451-4149