MEDICARE: SERENITY SPRINGS 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528758430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY SPRINGS HOME CARE LLC

Provider Business Mailing Address
First Line	:	5500 TIDEWATER DRIVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509
Country	:	US
Telephone Number	:	757-636-1723
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 TIDEWATER DRIVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509
Country	:	US
Telephone Number	:	757-636-1723
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAESHAWN LAVAR BARHAM
Credential	:
Telephone Number	:	757-636-1723

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	12/05/2025

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