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General NPI Number Information
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NPI Number | 1487322426
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Entity Type | Organization
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Legal Business Name | SOUTHERN SERENITY HOME CARE
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 830 SPRING CREEK RD # C
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City | BAINBRIDGE
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State | GA
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Zip | 39817-3554
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Country | US
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Telephone | 229-205-5032
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Fax |
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Provider Business Mailing Address
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Address Line | 925 S WEST ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4519
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Country | US
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Telephone | 229-205-5032
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Fax | 229-246-7564
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Authorized Official
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Title or Position | OWNER
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Name | SHAQUIRAH SCREEN
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Credential |
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Telephone | 229-205-5032
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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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Taxonomy #2
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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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