Healthcare Provider Details

I. General information

NPI: 1538345079
Provider Name (Legal Business Name): SERENITY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 FRANCIS ST
SAINT JOSEPH MO
64501-1928
US

IV. Provider business mailing address

620 FRANCIS ST SUITE 222
SAINT JOSEPH MO
64501-1928
US

V. Phone/Fax

Practice location:
  • Phone: 816-901-0262
  • Fax: 816-279-0499
Mailing address:
  • Phone: 816-901-0262
  • Fax: 816-232-5052

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIN EDDINS
Title or Position: DESIGNATED MANAGER
Credential:
Phone: 816-901-0262