- Enrollment id
- O20240701001567
- Enrollment state
- UT
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1821858820
- Multiple npi flag
- N
- Ccn
- 467366
- Associate id
- 4082158100
- Organization name
- SERENITY HOME HEALTH OF UTAH LLC
- Incorporation date
- 2024-03-19
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 627 W 4000 N
- City
- PLEASANT GROVE
- State
- UT
- Zip code
- 840628754