Healthcare Provider Details

I. General information

NPI: 1225750243
Provider Name (Legal Business Name): SERENITY HOME, ADULT DAYCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18955 PARKSIDE STREET 18955 PARKSIDE STREET
DETROIT MI
48221
US

IV. Provider business mailing address

18955 PARKSIDE STREET 18955 PARKSIDE STREET
DETROIT MI
48221
US

V. Phone/Fax

Practice location:
  • Phone: 313-319-4917
  • Fax:
Mailing address:
  • Phone: 313-319-4917
  • 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: MS. SAUNDON DENICE BRANNON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 313-319-4917