Healthcare Provider Details

I. General information

NPI: 1801657341
Provider Name (Legal Business Name): SERENITY INNOVATIVE CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 N PARHAM RD STE 602A
HENRICO VA
23294-4417
US

IV. Provider business mailing address

305 S WASHINGTON HWY STE G7
ASHLAND VA
23005-2257
US

V. Phone/Fax

Practice location:
  • Phone: 804-250-9426
  • Fax: 804-446-5915
Mailing address:
  • Phone: 804-250-9426
  • 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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY JEANIA ROACH
Title or Position: ADMINSTRATOR
Credential:
Phone: 901-603-7741