Provider Demographics
NPI:1104678457
Name:SERENITY LIGHT CARE SERVICES
Entity type:Organization
Organization Name:SERENITY LIGHT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ABETA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KBYII
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-260-6674
Mailing Address - Street 1:PO BOX 4453
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-0453
Mailing Address - Country:US
Mailing Address - Phone:216-260-6674
Mailing Address - Fax:
Practice Address - Street 1:1817 LAMPSON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1569
Practice Address - Country:US
Practice Address - Phone:216-260-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care