1437302056 NPI number — SERENITY HOME CARE SERVICES, P.C.

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 1437302056 NPI number — SERENITY HOME CARE SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY HOME CARE SERVICES, P.C.
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:
6
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:
1437302056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17800 WOODWARD AVENUE
Provider Second Line Business Mailing Address:
SUITE 100 C
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48203-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-865-0598
Provider Business Mailing Address Fax Number:
313-865-4723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17800 WOODWARD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100 C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48203-2259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-865-0598
Provider Business Practice Location Address Fax Number:
313-865-4723
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AZUBOGU
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
EMEKA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
313-865-0598

Provider Taxonomy Codes

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

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





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