MEDICARE: SERENE HAVEN HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	29397	MN

General Provider Information

NPI Number	:	1013353648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE HAVEN HOME CARE

Provider Business Mailing Address
First Line	:	20620 COUNTY HIGHWAY 33
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-8244
Country	:	US
Telephone Number	:	218-205-1361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 RIDGEVIEW TER NE
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-8684
Country	:	US
Telephone Number	:	218-205-1361
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA BESKE
Credential	:
Telephone Number	:	218-205-1361

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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