Healthcare Provider Details

I. General information

NPI: 1003289406
Provider Name (Legal Business Name): SERENITY LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 OAKVIEW DR
DILWORTH MN
56529-1827
US

IV. Provider business mailing address

1125 OAKVIEW DR
DILWORTH MN
56529-1827
US

V. Phone/Fax

Practice location:
  • Phone: 218-477-7254
  • Fax: 218-477-7255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number372061
License Number StateMN

VIII. Authorized Official

Name: MR. RICHARD ANDERSON
Title or Position: MANAGER
Credential:
Phone: 218-477-7254