MEDICARE: SERENITY RESIDENTIAL SERVICES 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1972466597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY RESIDENTIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	809 WOODBRIDGE PKWY STE 500
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-7151
Country	:	US
Telephone Number	:	614-602-7035
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 HUNTERS GLN
Second Line	:
City	:	MURPHY
State	:	TX
Zip	:	75094-4375
Country	:	US
Telephone Number	:	614-602-7035
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	ASIYA MOHAMED
Credential	:
Telephone Number	:	614-602-7035

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “SERENITY RESIDENTIAL SERVICES LLC ” Practice Location

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