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General NPI Number Information
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NPI Number | 1154839488
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Entity Type | Organization
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Legal Business Name | SERENITY GARDENS HOME HEALTH SERVICES LLC.
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 3002 S JEFFERSON AVE STE 201
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City | SAINT LOUIS
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State | MO
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Zip | 63118
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Country | US
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Telephone | 314-458-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 S JEFFERSON AVE STE 201
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TYRONE CAIN
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Credential |
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Telephone | 800-491-4463
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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 | MO
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