Healthcare Provider Details

I. General information

NPI: 1154751261
Provider Name (Legal Business Name): SERENITY TREE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 12/03/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 20TH ST NW STE A
CANTON OH
44708-2160
US

IV. Provider business mailing address

1348 WOODLAND AVE NW
CANTON OH
44703-1848
US

V. Phone/Fax

Practice location:
  • Phone: 234-458-2002
  • Fax: 330-576-5918
Mailing address:
  • Phone: 234-258-5153
  • Fax: 330-576-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARONDA M REESE
Title or Position: CEO/ DIRECTOR OF OPERATIONS
Credential: BBA
Phone: 234-458-2002