Provider Demographics
NPI:1861219065
Name:JEMA SERENE LLC
Entity type:Organization
Organization Name:JEMA SERENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJAGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-708-4006
Mailing Address - Street 1:1436 W PIMA AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-9490
Mailing Address - Country:US
Mailing Address - Phone:480-708-4006
Mailing Address - Fax:
Practice Address - Street 1:1436 W PIMA AVE
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-9490
Practice Address - Country:US
Practice Address - Phone:480-708-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care