Healthcare Provider Details

I. General information

NPI: 1285386581
Provider Name (Legal Business Name): SERENITY PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 S RAINBOW BLVD STE 131
LAS VEGAS NV
89146-6208
US

IV. Provider business mailing address

3311 S RAINBOW BLVD STE 131
LAS VEGAS NV
89146-6208
US

V. Phone/Fax

Practice location:
  • Phone: 702-368-6880
  • Fax: 702-213-9042
Mailing address:
  • Phone: 702-368-6880
  • Fax: 702-213-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: LORITA TANAHAN
Title or Position: OWNER
Credential:
Phone: 702-368-6880