Healthcare Provider Details

I. General information

NPI: 1144901539
Provider Name (Legal Business Name): SERENITY COMMUNITY SERVICE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VILLAGE DR
OAKLAND TN
38060-4856
US

IV. Provider business mailing address

105 VILLAGE DR
OAKLAND TN
38060-4856
US

V. Phone/Fax

Practice location:
  • Phone: 901-627-8515
  • Fax: 901-424-9083
Mailing address:
  • Phone: 190-162-7851
  • Fax: 901-424-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN A CANE
Title or Position: CEO
Credential:
Phone: 615-710-9535