Provider Demographics
NPI:1316452154
Name:SERENITY LIFE HEALTHCARE
Entity type:Organization
Organization Name:SERENITY LIFE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-801-1115
Mailing Address - Street 1:2470 WINDY HILL RD SE STE 417
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8625
Mailing Address - Country:US
Mailing Address - Phone:888-801-1115
Mailing Address - Fax:678-653-9603
Practice Address - Street 1:2470 WINDY HILL RD SE STE 417
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8625
Practice Address - Country:US
Practice Address - Phone:888-801-1115
Practice Address - Fax:678-653-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003253807AMedicaid