Healthcare Provider Details

I. General information

NPI: 1295117844
Provider Name (Legal Business Name): SERENITY ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BOWLES AVE SUITE A
FENTON MO
63026-2310
US

IV. Provider business mailing address

1525 BOWLES AVE SUITE A
FENTON MO
63026-2310
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-1600
  • Fax: 636-343-1496
Mailing address:
  • Phone: 636-343-1600
  • Fax: 636-343-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLYN DOWD
Title or Position: OWNER
Credential:
Phone: 636-343-1600