Provider Demographics
NPI:1184787459
Name:SERENITY HOME HEALTH CARE AGENCY, LLC
Entity type:Organization
Organization Name:SERENITY HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:SHINA
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:586-749-2273
Mailing Address - Street 1:667 E BIG BEAVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1430
Mailing Address - Country:US
Mailing Address - Phone:586-749-2273
Mailing Address - Fax:586-749-2277
Practice Address - Street 1:667 E BIG BEAVER RD STE 105
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1430
Practice Address - Country:US
Practice Address - Phone:586-749-2273
Practice Address - Fax:586-749-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239009Medicare Oscar/Certification