Provider Demographics
NPI:1679878847
Name:SERENITY LAKES HOME CARE
Entity type:Organization
Organization Name:SERENITY LAKES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BESKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-205-6753
Mailing Address - Street 1:503 NORTH LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515
Mailing Address - Country:US
Mailing Address - Phone:218-205-6753
Mailing Address - Fax:
Practice Address - Street 1:503 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-4056
Practice Address - Country:US
Practice Address - Phone:218-205-6753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health