MEDICARE: SERENITY LIGHT CARE SERVICES

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1104678457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY LIGHT CARE SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 4453
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-0453
Country	:	US
Telephone Number	:	216-260-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 LAMPSON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1569
Country	:	US
Telephone Number	:	216-260-6674
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. ABETA E KBYII
Credential	:	RN
Telephone Number	:	216-260-6674

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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