Serenity Physician

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

Legal business name

SERENITY PHYSICIAN

Practice address

1009 Drexel St
Dearborn, MI 48128-1639

Phone

(313) 429-3164

Fax

(313) 429-3165

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Simms

Title

Manager

Phone

(313) 320-5356

Specialties & licenses 1

Addresses

Other names 1

• Serenity Physician Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861591687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 DREXEL ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281639",
            "telephone_number": "313-429-3164",
            "fax_number": "313-429-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 DREXEL ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281639",
            "telephone_number": "313-429-3164",
            "fax_number": "313-429-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY PHYSICIAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-320-5356"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor, Home Modifications",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Physician",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Senior Independence Home Care LLC
• Jessica Sepulveda
• Serenity Home Hospice LLC
• Serenity in Home Care
• Serenity Path LLC
• Serenity Physicians
• Serenity Step LLC
• Lana Hassan Serhan
• Samantha Sermack
• Nicholas Nathan Serocki, CGC

• Home Modifications Contractor in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Home Modifications Contractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.