Healthcare Provider Details

I. General information

NPI: 1801601273
Provider Name (Legal Business Name): SERENE WINGS OF WELLNESS CONCIERGE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 BARKER CYPRESS RD STE 230
HOUSTON TX
77084-7532
US

IV. Provider business mailing address

3660 BARKER CYPRESS RD STE 230
HOUSTON TX
77084-7532
US

V. Phone/Fax

Practice location:
  • Phone: 346-412-9168
  • Fax:
Mailing address:
  • Phone: 346-412-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUTH BUSTOS
Title or Position: CEO/DIRECTOR OF CLINICAL SERVICES
Credential: RN
Phone: 346-412-9168