Provider Demographics
NPI:1487091849
Name:HOME SERENITY LLC
Entity type:Organization
Organization Name:HOME SERENITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA CERTIFICATE
Authorized Official - Phone:248-797-0476
Mailing Address - Street 1:1742 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4406
Mailing Address - Country:US
Mailing Address - Phone:248-231-4133
Mailing Address - Fax:
Practice Address - Street 1:1742 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4406
Practice Address - Country:US
Practice Address - Phone:248-231-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-25
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID7101U251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health