Healthcare Provider Details

I. General information

NPI: 1619424504
Provider Name (Legal Business Name): SERENITYS WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11557 STATE ROUTE 45
LISBON OH
44432-8621
US

IV. Provider business mailing address

11557 STATE ROUTE 45
LISBON OH
44432-8621
US

V. Phone/Fax

Practice location:
  • Phone: 330-271-9817
  • Fax:
Mailing address:
  • Phone: 330-271-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number7609010
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MILDRED E ILER
Title or Position: CEO
Credential: LPN
Phone: 13302719817