Provider Demographics
NPI:1215315528
Name:SERENITYHOMECARE
Entity type:Organization
Organization Name:SERENITYHOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCA
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNENA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:STAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-942-9401
Mailing Address - Street 1:1512 CLINTON RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5400
Mailing Address - Country:US
Mailing Address - Phone:601-942-9401
Mailing Address - Fax:
Practice Address - Street 1:1512 CLINTON RAYMOND RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5400
Practice Address - Country:US
Practice Address - Phone:601-942-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDOMO5355311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home