Healthcare Provider Details

I. General information

NPI: 1487213336
Provider Name (Legal Business Name): SERENITY SENIOR CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N CEDAR AVE
HIGHLAND SPRINGS VA
23075-1429
US

IV. Provider business mailing address

126 N CEDAR AVE
HIGHLAND SPRINGS VA
23075-1429
US

V. Phone/Fax

Practice location:
  • Phone: 804-999-1719
  • Fax:
Mailing address:
  • Phone: 804-999-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DESIREE LANCASTER-BUSSEY
Title or Position: CEO
Credential:
Phone: 804-999-1719