Healthcare Provider Details

I. General information

NPI: 1043024391
Provider Name (Legal Business Name): SERENITY ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 S VENTURA DRIVE
OKLAHOMA CITY OK
73135
US

IV. Provider business mailing address

P.O BOX 55811
OKLAHOMA CITY OK
73155
US

V. Phone/Fax

Practice location:
  • Phone: 405-627-8552
  • Fax: 405-455-1215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: EVONNDA JEAN FIELDS
Title or Position: CEO
Credential: MSW
Phone: 405-627-8552