Healthcare Provider Details

I. General information

NPI: 1124819586
Provider Name (Legal Business Name): SERENITY LIFE HOME CARE L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 EUCLID AVE STE 819
CLEVELAND OH
44114-3315
US

IV. Provider business mailing address

850 EUCLID AVE STE 819
CLEVELAND OH
44114-3315
US

V. Phone/Fax

Practice location:
  • Phone: 216-858-6199
  • Fax:
Mailing address:
  • Phone: 216-858-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DESHONA DOUGLAS
Title or Position: OWNER/ OPERATOR
Credential:
Phone: 216-858-6199