=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891156691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY HOME HEALTHCARE-WARRENTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2016
-----------------------------------------------------
Last Update Date | 03/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 KEITH ST SUITE 3
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20186-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-763-0484
-----------------------------------------------------
Fax | 540-680-2641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 KEITH ST SUITE 3
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20186-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-763-0484
-----------------------------------------------------
Fax | 540-680-2641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MANAGER
-----------------------------------------------------
Name | NANA A QUANSAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-763-0484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-161415
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------