MEDICARE: SERENITY LIVING HOME CARE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1295510923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY LIVING HOME CARE LLC

Provider Business Mailing Address
First Line	:	3927 BUTTERCUP CIR S
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5670
Country	:	US
Telephone Number	:	407-219-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3927 BUTTERCUP CIR S
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5670
Country	:	US
Telephone Number	:	407-219-8055
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MS. STEPHANIE HEREDIA
Credential	:
Telephone Number	:	407-219-8055

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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