Healthcare Provider Details

I. General information

NPI: 1215676077
Provider Name (Legal Business Name): SERENITY AT WOODLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 WHITETAIL DR
CASTLE ROCK CO
80104-2809
US

IV. Provider business mailing address

25828 E CALHOUN PL
AURORA CO
80016-4399
US

V. Phone/Fax

Practice location:
  • Phone: 720-301-1369
  • Fax:
Mailing address:
  • Phone: 720-301-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier88-2518706
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: ROZELLE CAWTHORN
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-301-1369