Healthcare Provider Details

I. General information

NPI: 1821926767
Provider Name (Legal Business Name): VIV SERENITY HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75111 NASSAU STATION WAY
YULEE FL
32097-3862
US

IV. Provider business mailing address

192 SW INWOOD AVE
PORT SAINT LUCIE FL
34984-4917
US

V. Phone/Fax

Practice location:
  • Phone: 347-888-8623
  • Fax:
Mailing address:
  • Phone: 347-888-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VIVETTE MALCOLM
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 347-888-8623