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General NPI Number Information
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NPI Number | 1902243900
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Entity Type | Organization
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Legal Business Name | SERENITY HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 11130 MICHELHAM DR STE. K
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6404
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Country | US
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Telephone | 314-359-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 11130 MICHELHAM DR STE. K
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6404
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Country | US
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Telephone | 314-359-5542
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Fax |
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Authorized Official
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Title or Position | DESIGNATED MANAGER
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Name | TIARA ROCHELLE WHITE
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Credential |
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Telephone | 314-359-5542
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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 |
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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 | LC1314718
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License Number State | MO
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