Provider Demographics
NPI:1063233450
Name:SERENITY HOME HEALTHCARE
Entity type:Organization
Organization Name:SERENITY HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-903-3007
Mailing Address - Street 1:4853 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1117
Mailing Address - Country:US
Mailing Address - Phone:317-903-3007
Mailing Address - Fax:463-900-1728
Practice Address - Street 1:4853 OAKBROOK DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1117
Practice Address - Country:US
Practice Address - Phone:317-903-3007
Practice Address - Fax:463-900-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health