Healthcare Provider Details

I. General information

NPI: 1194193789
Provider Name (Legal Business Name): SERENITY TRANSPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 N PRESIDIO DR APT D
MILWAUKEE WI
53223-6306
US

IV. Provider business mailing address

7030 N PRESIDIO DR APT D
MILWAUKEE WI
53223-6306
US

V. Phone/Fax

Practice location:
  • Phone: 414-610-3792
  • Fax:
Mailing address:
  • Phone: 414-610-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number2788344
License Number StateWI

VIII. Authorized Official

Name: FRANCISCA S RODRIGUEZ
Title or Position: MANAGER
Credential:
Phone: 414-610-3792