MEDICARE: HOME SERENITY 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	251E00000X	Home Health Agency	D7101U	MI

General Provider Information

NPI Number	:	1487091849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SERENITY LLC

Provider Business Mailing Address
First Line	:	1742 HUNTINGTON AVE
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-4406
Country	:	US
Telephone Number	:	248-231-4133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1742 HUNTINGTON AVE
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-4406
Country	:	US
Telephone Number	:	248-231-4133
Fax Number	:

Authorized Official
Title or Position	:	CNA/OWNER
Name	:	MS. JUNE WATKINS
Credential	:	CNA CERTIFICATE
Telephone Number	:	248-797-0476

Provider Enumeration Date	:	05/25/2013
Last Update Date	:	12/05/2013

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