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General NPI Number Information
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NPI Number | 1083401459
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Entity Type | Organization
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Legal Business Name | BRANCH OF SERENITY HOME CARE AGENCY
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 2261 LEMA CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-1848
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Country | US
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Telephone | 463-245-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 2261 LEMA CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-1848
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Country | US
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Telephone | 463-245-8806
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR/OWNER
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Name | MRS. KYLA NICOLE SHELTON
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Credential | LPN
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Telephone | 463-245-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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