Provider Demographics
NPI:1295583128
Name:SERENTIY LIVING HOMECARE
Entity type:Organization
Organization Name:SERENTIY LIVING HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-431-7241
Mailing Address - Street 1:364 N PARKWAY STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2874
Mailing Address - Country:US
Mailing Address - Phone:731-736-1005
Mailing Address - Fax:731-736-1111
Practice Address - Street 1:364 N PARKWAY STE 8
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2874
Practice Address - Country:US
Practice Address - Phone:731-736-1005
Practice Address - Fax:731-736-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care