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General NPI Number Information
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NPI Number | 1104219120
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Entity Type | Organization
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Legal Business Name | SERENITY HOME CARE, LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 316 CENTRAL AVE SUITE 2 LL
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City | FARIBAULT
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State | MN
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Zip | 55021
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Country | US
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Telephone | 507-201-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 8151 33RD AVE S 609E
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4518
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Country | US
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Telephone | 651-235-1403
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JOHN LUNDSTROM
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Credential | D.C.
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Telephone | 651-235-1403
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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 |
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License Number State |
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