MEDICARE: SERENITY LIFESTYLE PLUS LLC

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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730889494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY LIFESTYLE PLUS LLC

Provider Business Mailing Address
First Line	:	482 BRIGHTON AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2023
Country	:	US
Telephone Number	:	617-438-2866
Fax Number	:	321-951-4070

Provider Business Practice Location Address
First Line	:	482 BRIGHTON AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2023
Country	:	US
Telephone Number	:	617-438-2866
Fax Number	:	321-951-4070

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. ANALISA DUNCAN
Credential	:
Telephone Number	:	617-438-2866

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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