Provider Demographics
NPI:1427656651
Name:SERENITY HOME CARE LLC
Entity type:Organization
Organization Name:SERENITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-688-9942
Mailing Address - Street 1:4451 W ST ANNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6232
Mailing Address - Country:US
Mailing Address - Phone:602-688-9942
Mailing Address - Fax:
Practice Address - Street 1:6858 S 19TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5770
Practice Address - Country:US
Practice Address - Phone:858-413-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-10
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities