MEDICARE: SERENITY HAVEN PLACE LLC

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1023973583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HAVEN PLACE LLC

Provider Business Mailing Address
First Line	:	3329 LONG MEADOW CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 LONG MEADOW CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3248
Country	:	US
Telephone Number	:	313-708-1138
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY LUCAS
Credential	:
Telephone Number	:	313-708-1138

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1184732406 — EBRAHIM VERSI M.D.
Practice Location Address:

6585 CITY WEST PKWY
EDEN PRAIRIE, MN
55344-3248

Practice Phone: 908-698-2390
Practice Fax:

1184798605 — REDPHARM DRUG, INC.
Practice Location Address:

6501 CITY WEST PKWY
EDEN PRAIRIE, MN
55344-3248

Practice Phone: 952-653-2525
Practice Fax:

1710206636 — THEDACARE MEDICAL CENTER - SHAWANO, INC.
Practice Location Address:

6501 CITY WEST PKWY
EDEN PRAIRIE, MN
55344-3248

Practice Phone: 715-526-7328
Practice Fax:

1245539832 — INSTYMEDS CORPORATION
Practice Location Address:

6501 CITY WEST PKWY
EDEN PRAIRIE, MN
55344-3248

Practice Phone: 952-653-2525
Practice Fax:

1548557622 — HALEY B NELSON FNP, NP-C, APRN
Practice Location Address:

7353 S 2172 W
WEST JORDAN, UT
84084-3248

Practice Phone: 801-703-3257
Practice Fax:

Directions to “SERENITY HAVEN PLACE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.