Healthcare Provider Details

I. General information

NPI: 1952672206
Provider Name (Legal Business Name): SERENITY FAMILY CARE AND CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WESTERN AVE
ROCKY MOUNT NC
27804-5540
US

IV. Provider business mailing address

1003 WESTERN AVE
ROCKY MOUNT NC
27804-5540
US

V. Phone/Fax

Practice location:
  • Phone: 252-366-3899
  • Fax: 252-200-4870
Mailing address:
  • Phone: 252-366-3899
  • Fax: 252-200-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS RENEA WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-366-3899