Healthcare Provider Details

I. General information

NPI: 1992106496
Provider Name (Legal Business Name): SERENITY PLACE FAMILY CARE GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CARRINGTON DR
ORLANDO FL
32807-5206
US

IV. Provider business mailing address

2011 CARRINGTON DR
ORLANDO FL
32807-5206
US

V. Phone/Fax

Practice location:
  • Phone: 407-914-8731
  • Fax:
Mailing address:
  • Phone: 407-914-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MISS CARMEL NATALIE GABRIEL
Title or Position: CERTIFIED NURSING ASSISTANT
Credential: CNA
Phone: 407-914-8731