Healthcare Provider Details

I. General information

NPI: 1548799216
Provider Name (Legal Business Name): SERENITY HOMES-NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 HAYES STREET
MARNE MI
49435
US

IV. Provider business mailing address

3109 LAWTON DR NE
GRAND RAPIDS MI
49525-2916
US

V. Phone/Fax

Practice location:
  • Phone: 616-677-6015
  • Fax: 616-431-5038
Mailing address:
  • Phone: 616-361-6571
  • Fax: 616-361-0852

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: ABRAHAM JOSHUA
Title or Position: ADMINISTRATOR
Credential:
Phone: 616-550-6411