Provider Demographics
NPI:1427823798
Name:SERENITY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SERENITY HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-833-3180
Mailing Address - Street 1:301 SOVEREIGN CT STE 209
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4435
Mailing Address - Country:US
Mailing Address - Phone:314-833-3180
Mailing Address - Fax:
Practice Address - Street 1:301 SOVEREIGN CT STE 209
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4435
Practice Address - Country:US
Practice Address - Phone:314-833-3180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty