Healthcare Provider Details

I. General information

NPI: 1194014001
Provider Name (Legal Business Name): SERENIY FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 BLAND SCHOOL RD
HARRELLS NC
28444-7609
US

IV. Provider business mailing address

PO BOX 377
HARRELLS NC
28444-0377
US

V. Phone/Fax

Practice location:
  • Phone: 910-532-4805
  • Fax: 910-532-2766
Mailing address:
  • Phone: 910-532-4805
  • Fax: 910-532-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCH-082-017
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberFCH-082-017
License Number StateNC

VIII. Authorized Official

Name: MRS. ERICA TERESA FENNELL
Title or Position: OWNER
Credential:
Phone: 910-337-2590