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General NPI Number Information
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NPI Number | 1013353648
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Entity Type | Organization
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Legal Business Name | SERENE HAVEN HOME CARE
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 1202 RIDGEVIEW TER NE
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City | ALEXANDRIA
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State | MN
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Zip | 56308-8684
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Country | US
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Telephone | 218-205-1361
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Fax |
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Provider Business Mailing Address
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Address Line | 20620 COUNTY HIGHWAY 33
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City | FERGUS FALLS
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State | MN
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Zip | 56537-8244
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Country | US
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Telephone | 218-205-1361
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA BESKE
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Credential |
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Telephone | 218-205-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 29397
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License Number State | MN
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