Healthcare Provider Details

I. General information

NPI: 1225668767
Provider Name (Legal Business Name): SERENITY HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 GREENVILLE HWY
WELLFORD SC
29385-9541
US

IV. Provider business mailing address

10541 GREENVILLE HWY
WELLFORD SC
29385-9541
US

V. Phone/Fax

Practice location:
  • Phone: 864-564-1752
  • Fax:
Mailing address:
  • Phone: 864-564-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHADRIAN JONES
Title or Position: OWNER
Credential:
Phone: 864-564-1752