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General NPI Number Information
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NPI Number | 1871132480
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Entity Type | Organization
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Legal Business Name | SERENITY SUPPLIES
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 1420 W 26TH CT
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4123
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Country | US
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Telephone | 561-601-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 W 26TH CT
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4123
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Country | US
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Telephone | 561-601-7773
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | SIMONE JACKSON
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Credential | MA
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Telephone | 561-601-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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