MEDICARE: SERENITY SPRINGS GROUP HOME

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1720847262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY SPRINGS GROUP HOME

Provider Business Mailing Address
First Line	:	2253 HESS AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-8305
Country	:	US
Telephone Number	:	513-488-6405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2253 HESS AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-8305
Country	:	US
Telephone Number	:	513-488-6405
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALEESE WILLIS
Credential	:
Telephone Number	:	513-488-6405

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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Directions to “SERENITY SPRINGS GROUP HOME ” Practice Location

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