Healthcare Provider Details

I. General information

NPI: 1508557430
Provider Name (Legal Business Name): SERENITY HILL HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HICKMAN RD
TABOR CITY NC
28463-2038
US

IV. Provider business mailing address

319 HAMILTON DR
CONYERS GA
30094-8102
US

V. Phone/Fax

Practice location:
  • Phone: 770-598-3426
  • Fax:
Mailing address:
  • Phone: 770-598-3426
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AVONDA COX
Title or Position: OWNER
Credential: DIRECTOR
Phone: 770-598-3426