MEDICARE: SERENITY SENIOR SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1588844732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY SENIOR SERVICES

Provider Business Mailing Address
First Line	:	1029 S VICTORY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-7948
Country	:	US
Telephone Number	:	832-338-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 S VICTORY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-7948
Country	:	US
Telephone Number	:	832-338-0690
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. ROCHELL WILLIAMS
Credential	:
Telephone Number	:	832-338-0690

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/12/2007

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Directions to “SERENITY SENIOR SERVICES ” Practice Location

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