MEDICARE: SERENE WINGS OF WELLNESS CONCIERGE HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	163WH0200X	Home Health Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801601273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE WINGS OF WELLNESS CONCIERGE HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3660 BARKER CYPRESS RD STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7532
Country	:	US
Telephone Number	:	346-412-9168
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 BARKER CYPRESS RD STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7532
Country	:	US
Telephone Number	:	346-412-9168
Fax Number	:

Authorized Official
Title or Position	:	CEO/DIRECTOR OF CLINICAL SERVICES
Name	:	RUTH BUSTOS
Credential	:	RN
Telephone Number	:	346-412-9168

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	03/07/2025

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