Provider Demographics
NPI:1609611250
Name:SERENDIVINE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:SERENDIVINE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COCO
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:RIDEOUT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-551-6968
Mailing Address - Street 1:3716 RUSACK DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6443
Mailing Address - Country:US
Mailing Address - Phone:254-551-6968
Mailing Address - Fax:
Practice Address - Street 1:3716 RUSACK DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6443
Practice Address - Country:US
Practice Address - Phone:254-551-6968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty