Healthcare Provider Details

I. General information

NPI: 1568304855
Provider Name (Legal Business Name): SERENITY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PINE ST
SPARKS GA
31647-7422
US

IV. Provider business mailing address

PO BOX 947
PERRY GA
31069-0947
US

V. Phone/Fax

Practice location:
  • Phone: 229-549-6620
  • Fax:
Mailing address:
  • Phone: 478-714-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES PETTIS
Title or Position: PRESIDENT
Credential:
Phone: 478-714-0246