=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073448437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY ADULT HOME CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2026
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 RUSSELL ST
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29115-6053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-290-6684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 RUSSELL ST STE 14
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29115-6071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-290-6684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FELICIA SHAREEF
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 803-290-6684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------