Provider Demographics
NPI:1528782208
Name:SERENITY ALL AGE HOME CARE LLC
Entity type:Organization
Organization Name:SERENITY ALL AGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERCENTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-931-4602
Mailing Address - Street 1:109 AMBERSWEET WAY # 240
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8418
Mailing Address - Country:US
Mailing Address - Phone:954-931-4602
Mailing Address - Fax:
Practice Address - Street 1:3370 BEAU RIVAGE DR APT E2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2045
Practice Address - Country:US
Practice Address - Phone:954-931-4602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health