Provider Demographics
NPI:1902521552
Name:SERENITY HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:SERENITY HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-296-6556
Mailing Address - Street 1:1710 LEER DR STE A
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5446
Mailing Address - Country:US
Mailing Address - Phone:574-327-2357
Mailing Address - Fax:574-235-6991
Practice Address - Street 1:14500 STATE ROAD 23 STE 6
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5632
Practice Address - Country:US
Practice Address - Phone:574-327-2357
Practice Address - Fax:574-235-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies