Healthcare Provider Details

I. General information

NPI: 1346596541
Provider Name (Legal Business Name): SERENITY ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 CROSS ST 1000 DOUGLAS ST
CLEVELAND MS
38732-3906
US

IV. Provider business mailing address

824 CROSS ST
CLEVELAND MS
38732-3906
US

V. Phone/Fax

Practice location:
  • Phone: 662-719-8603
  • Fax:
Mailing address:
  • Phone: 662-719-8603
  • 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. TREVA EVANS GILES
Title or Position: OWNER
Credential:
Phone: 662-719-8603