Provider Demographics
NPI:1093553851
Name:AUTUMN SERENITY HEALTHCARE, LLC
Entity type:Organization
Organization Name:AUTUMN SERENITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIKITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:901-493-9265
Mailing Address - Street 1:14480 HIGHWAY 76 N
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-5244
Mailing Address - Country:US
Mailing Address - Phone:901-493-9265
Mailing Address - Fax:
Practice Address - Street 1:14480 HIGHWAY 76 N
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-5244
Practice Address - Country:US
Practice Address - Phone:901-493-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care