MEDICARE: SERENITY WAY TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1184399743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY WAY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3903 GRAMMONT ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-4429
Country	:	US
Telephone Number	:	318-605-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 GRAMMONT ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-4429
Country	:	US
Telephone Number	:	318-605-5108
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN TONY O FOSTER
Credential	:
Telephone Number	:	318-605-5108

Provider Enumeration Date	:	08/14/2021
Last Update Date	:	08/14/2021

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