Healthcare Provider Details

I. General information

NPI: 1518747518
Provider Name (Legal Business Name): SERENITY HOME CARE SPECIALTY ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 PEPPERMILL LN
MEMPHIS TN
38125-3441
US

IV. Provider business mailing address

7131 PEPPERMILL LN
MEMPHIS TN
38125-3441
US

V. Phone/Fax

Practice location:
  • Phone: 901-282-0236
  • Fax:
Mailing address:
  • Phone: 901-282-0236
  • 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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATOYA MICHELLE WALLS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 901-282-0236