MEDICARE: THE LANDING AT SERENITY, 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	324500000X	Substance Abuse Rehabilitation Facility	904454	MD

General Provider Information

NPI Number	:	1851767982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LANDING AT SERENITY, LLC

Provider Business Mailing Address
First Line	:	1783 FOREST DR # 226
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4229
Country	:	US
Telephone Number	:	240-277-4802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 SAINT STEPHENS WOODS DR
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-2200
Country	:	US
Telephone Number	:	240-277-4802
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LARRY ADLER
Credential	:
Telephone Number	:	240-277-4802

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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