Healthcare Provider Details

I. General information

NPI: 1497254940
Provider Name (Legal Business Name): SERENITY UNLIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 WASHINGTON ST
LEETSDALE PA
15056-1006
US

IV. Provider business mailing address

412 WASHINGTON ST
LEETSDALE PA
15056-1006
US

V. Phone/Fax

Practice location:
  • Phone: 412-452-7142
  • Fax:
Mailing address:
  • Phone: 412-452-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number33603601
License Number StatePA

VIII. Authorized Official

Name: MR. COREY D PHARR
Title or Position: PRESIDENT/CEO
Credential:
Phone: 412-452-7142