Healthcare Provider Details

I. General information

NPI: 1578757811
Provider Name (Legal Business Name): SWEET SERENITY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 BOZY RD LOT 70
SCRANTON SC
29591-5738
US

IV. Provider business mailing address

1840 BOZY RD LOT 70
SCRANTON SC
29591-5738
US

V. Phone/Fax

Practice location:
  • Phone: 843-389-9024
  • Fax:
Mailing address:
  • Phone: 843-389-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CARRIE BURGESS HICKSON
Title or Position: NURSE
Credential: LPN
Phone: 843-389-9024