MEDICARE: SE-REN-I-TY HEALTH PLUS

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

General Provider Information

NPI Number	:	1184284390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SE-REN-I-TY HEALTH PLUS

Provider Business Mailing Address
First Line	:	929 N SPRING AVE STE C3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3629
Country	:	US
Telephone Number	:	314-437-3529
Fax Number	:	314-720-9273

Provider Business Practice Location Address
First Line	:	929 N SPRING AVE STE C3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3629
Country	:	US
Telephone Number	:	314-437-3529
Fax Number	:	314-720-9273

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KEWANA MARIE BROWN
Credential	:
Telephone Number	:	314-436-3529

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	11/01/2022

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