Healthcare Provider Details

I. General information

NPI: 1922984624
Provider Name (Legal Business Name): SERENITY GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 DUPONT AVE N
MINNEAPOLIS MN
55412-2510
US

IV. Provider business mailing address

1901 STEVENS AVE APT 2
MINNEAPOLIS MN
55403-3870
US

V. Phone/Fax

Practice location:
  • Phone: 612-836-9799
  • Fax:
Mailing address:
  • Phone: 612-836-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MUSTAFA FARAH
Title or Position: ASSISTED LIVING DIRECTOR
Credential: LALD
Phone: 612-836-9799