=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760724066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2013
-----------------------------------------------------
Last Update Date | 03/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 218 N WOOD AVE
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-925-1990
-----------------------------------------------------
Fax | 908-925-1968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 ANDERSON CT
-----------------------------------------------------
City | SAYREVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08872-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-387-0240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | EVELYN VARGAS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 908-925-1990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------