Healthcare Provider Details

I. General information

NPI: 1497306682
Provider Name (Legal Business Name): SERENITY SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HILLTOP DR
LAWRENCE KS
66044-4530
US

IV. Provider business mailing address

1008 WILDWOOD DR
LAWRENCE KS
66049-3752
US

V. Phone/Fax

Practice location:
  • Phone: 785-393-2689
  • Fax:
Mailing address:
  • Phone: 785-393-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERRY BOLDEN
Title or Position: C.E.O
Credential:
Phone: 785-393-2689