MEDICARE: SERENITY HEALTH CARE, INC.

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		CA

General Provider Information

NPI Number	:	1770638553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	1149 S GRAND AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-5013
Country	:	US
Telephone Number	:	626-914-8481
Fax Number	:	626-914-6812

Provider Business Practice Location Address
First Line	:	1149 S GRAND AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-5013
Country	:	US
Telephone Number	:	626-914-8481
Fax Number	:	626-914-6812

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. HELEN MARTIN
Credential	:
Telephone Number	:	626-914-8481

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	03/03/2008

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