Provider Demographics
NPI:1902460843
Name:SERENITY COMFORT CARE & FAMILY SERVICES
Entity Type:Organization
Organization Name:SERENITY COMFORT CARE & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:I
Authorized Official - Credentials:HOME HEALTH CARE
Authorized Official - Phone:718-559-0508
Mailing Address - Street 1:226 BEACH 98TH ST # 3
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2849
Mailing Address - Country:US
Mailing Address - Phone:718-569-0508
Mailing Address - Fax:833-318-2368
Practice Address - Street 1:226 BEACH 98TH ST # 3
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2849
Practice Address - Country:US
Practice Address - Phone:718-569-0508
Practice Address - Fax:833-318-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY708258455Medicaid