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: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SELBY AVE STE M
SAINT PAUL MN
55102-4520
US

IV. Provider business mailing address

400 SELBY AVE STE M
SAINT PAUL MN
55102-4520
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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KHADIR TABABOUANGA ALBERT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 952-210-4481