Healthcare Provider Details

I. General information

NPI: 1073486015
Provider Name (Legal Business Name): VALLEY SERENITY HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MORGAN AVE
OSHKOSH WI
54901-1767
US

IV. Provider business mailing address

1310 MORGAN AVE
OSHKOSH WI
54901-1767
US

V. Phone/Fax

Practice location:
  • Phone: 618-203-6891
  • Fax:
Mailing address:
  • Phone: 618-203-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MAMADOU COULIBALY
Title or Position: OWNER
Credential:
Phone: 618-203-6891