1114479094 NPI number — SERENE HOME CARE OF SARASOTA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114479094 NPI number — SERENE HOME CARE OF SARASOTA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENE HOME CARE OF SARASOTA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114479094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3802 EHRLICH RD
Provider Second Line Business Mailing Address:
SUITE 309-A
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33624-2378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-374-0268
Provider Business Mailing Address Fax Number:
813-252-6941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1903 NORTHGATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34234-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-374-0268
Provider Business Practice Location Address Fax Number:
813-252-6941
Provider Enumeration Date:
10/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SEGARRA
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
813-374-0268

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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