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General NPI Number Information
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NPI Number | 1861820391
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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 | 10/18/2013
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 9510 IRON BRIDGE RD 210
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6400
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Country | US
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Telephone | 804-318-1591
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Fax | 866-597-1700
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Provider Business Mailing Address
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Address Line | 9510 IRON BRIDGE RD 210
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6400
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Country | US
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Telephone | 804-318-1591
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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 | IVORI CAMPBELL
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Credential |
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Telephone | 804-318-1591
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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 | 1276591
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License Number State | VA
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