Provider Demographics
NPI:1699927533
Name:SERENITY HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:SERENITY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-2410
Mailing Address - Street 1:17376 W 12 MILE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2053
Mailing Address - Country:US
Mailing Address - Phone:248-557-2410
Mailing Address - Fax:248-557-2420
Practice Address - Street 1:17376 W 12 MILE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2053
Practice Address - Country:US
Practice Address - Phone:248-557-2410
Practice Address - Fax:248-557-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239219Medicare Oscar/Certification