1184787459 NPI number — SERENITY HOME HEALTH CARE AGENCY, LLC

Table of content: (NPI 1184787459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184787459 NPI number — SERENITY HOME HEALTH CARE AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY HOME HEALTH CARE AGENCY, 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:
1184787459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
667 E BIG BEAVER RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-749-2273
Provider Business Mailing Address Fax Number:
586-749-2277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
667 E BIG BEAVER RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-749-2273
Provider Business Practice Location Address Fax Number:
586-749-2277
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHINA
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
HANNA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-749-2273

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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