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General NPI Number Information
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NPI Number | 1891229779
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Entity Type | Organization
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Legal Business Name | SERENITY IN HOME CARE,LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 1409 WASHINGTON AVE STE 517
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1901
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Country | US
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Telephone | 314-696-8960
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Fax | 314-696-8960
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Provider Business Mailing Address
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Address Line | 1409 WASHINGTON AVE STE 517
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1901
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Country | US
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Telephone | 314-696-8960
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Fax | 314-696-8960
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SERITA MARSHALL
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Credential | RN
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Telephone | 314-769-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | LC9800049
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License Number State | MO
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