Provider Demographics
NPI:1699081893
Name:SERENITY HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:SERENITY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HILDIGARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:OFORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-763-0484
Mailing Address - Street 1:3130 GOLANSKY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4268
Mailing Address - Country:US
Mailing Address - Phone:703-763-0484
Mailing Address - Fax:703-670-5826
Practice Address - Street 1:3166 GOLANSKY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4263
Practice Address - Country:US
Practice Address - Phone:703-763-0484
Practice Address - Fax:703-670-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-12715251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health