Healthcare Provider Details

I. General information

NPI: 1932835022
Provider Name (Legal Business Name): SERENITY HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 RED OAK DR
MANVEL TX
77578-4258
US

IV. Provider business mailing address

PO BOX 3383
PEARLAND TX
77588-3383
US

V. Phone/Fax

Practice location:
  • Phone: 832-229-1468
  • Fax:
Mailing address:
  • Phone: 832-229-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DERINNA JONES
Title or Position: P/ADMIN
Credential:
Phone: 832-229-1468