MEDICARE: SERENITY 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	1276591	VA

General Provider Information

NPI Number	:	1861820391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	9510 IRON BRIDGE RD
Second Line	:	210
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6400
Country	:	US
Telephone Number	:	804-318-1591
Fax Number	:

Provider Business Practice Location Address
First Line	:	9510 IRON BRIDGE RD
Second Line	:	210
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6400
Country	:	US
Telephone Number	:	804-318-1591
Fax Number	:	866-597-1700

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	IVORI CAMPBELL
Credential	:
Telephone Number	:	804-318-1591

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	04/14/2015

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