Healthcare Provider Details

I. General information

NPI: 1508720970
Provider Name (Legal Business Name): RAHAB SERENITY HOME PHASE LL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 VERMONT AVE
WASHINGTON NC
27889-7467
US

IV. Provider business mailing address

108 WYNDHAM CIR APT B
GREENVILLE NC
27858-1663
US

V. Phone/Fax

Practice location:
  • Phone: 252-916-3132
  • Fax:
Mailing address:
  • Phone: 252-916-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANIYA LEWIS
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 252-916-3132