MEDICARE: SERENITY CHOICE HOMECARE

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	:	1750691903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY CHOICE HOMECARE

Provider Business Mailing Address
First Line	:	33459 CSAH 19
Second Line	:
City	:	SOUTH HAVEN
State	:	MN
Zip	:	55382-2821
Country	:	US
Telephone Number	:	320-398-8335
Fax Number	:	320-398-8335

Provider Business Practice Location Address
First Line	:	33459 CSAH 19
Second Line	:
City	:	SOUTH HAVEN
State	:	MN
Zip	:	55382-2821
Country	:	US
Telephone Number	:	320-398-8335
Fax Number	:	320-398-8335

Authorized Official
Title or Position	:	COE
Name	:	MRS. SARAH LYNN KNUTSON
Credential	:
Telephone Number	:	320-398-8335

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	04/07/2011

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