Provider Demographics
NPI:1720830086
Name:SERENITY HELP AT HOME
Entity type:Organization
Organization Name:SERENITY HELP AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-800-1279
Mailing Address - Street 1:15035 EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2803
Mailing Address - Country:US
Mailing Address - Phone:313-800-1279
Mailing Address - Fax:
Practice Address - Street 1:15035 EVANSTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2803
Practice Address - Country:US
Practice Address - Phone:313-800-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health