Healthcare Provider Details

I. General information

NPI: 1003204439
Provider Name (Legal Business Name): SERENITY CARE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 W ALLEGHENY AVE
PHILADELPHIA PA
19132-1014
US

IV. Provider business mailing address

3331 W ALLEGHENY AVE
PHILADELPHIA PA
19132-1014
US

V. Phone/Fax

Practice location:
  • Phone: 215-617-8519
  • Fax:
Mailing address:
  • Phone: 215-617-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1822022
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1822022
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1822022
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1822022
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1822022
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1822022
License Number StatePA

VIII. Authorized Official

Name: MRS. RYSHEENA WYNDER-PRESTON
Title or Position: OWNER
Credential: LSW, SOCIAL WORKER
Phone: 215-617-8519