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General NPI Number Information
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NPI Number | 1801657341
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Entity Type | Organization
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Legal Business Name | SERENITY INNOVATIVE CARE AGENCY
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 3108 N PARHAM RD STE 602A
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City | HENRICO
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State | VA
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Zip | 23294-4417
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Country | US
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Telephone | 804-250-9426
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Fax | 804-446-5915
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Provider Business Mailing Address
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Address Line | 305 S WASHINGTON HWY STE G7
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City | ASHLAND
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State | VA
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Zip | 23005-2257
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Country | US
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Telephone | 804-250-9426
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | TIFFANY JEANIA ROACH
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Credential |
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Telephone | 901-603-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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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 | 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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