Healthcare Provider Details

I. General information

NPI: 1033405402
Provider Name (Legal Business Name): SERENITY HOME HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 WOODSTOCK AVE
SAINT LOUIS MO
63136-4752
US

IV. Provider business mailing address

PO BOX 52256
JENNINGS MO
63136-8256
US

V. Phone/Fax

Practice location:
  • Phone: 314-395-6991
  • Fax:
Mailing address:
  • Phone: 314-395-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CAPRICE MICHELLE WILSON
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 314-625-3431