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General NPI Number Information
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NPI Number | 1912414368
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Entity Type | Organization
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Legal Business Name | SERENITY HEALTHCARE AGENCY
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 3050 W 114TH ST
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City | CLEVELAND
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State | OH
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Zip | 44111-1847
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Country | US
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Telephone | 216-904-9563
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 W 114TH ST
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City | CLEVELAND
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State | OH
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Zip | 44111-1847
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Country | US
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Telephone | 216-904-9563
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | PORTIA LANIECE HARRIS
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Credential | LPN
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Telephone | 216-904-9563
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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 |
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License Number State | OH
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