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General NPI Number Information
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NPI Number | 1033795794
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Entity Type | Organization
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Legal Business Name | SERENITY @ SHILOH LLC
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 1105 COLONIAL AVE
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City | GREENVILLE
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State | NC
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Zip | 27834-1828
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Country | US
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Telephone | 336-365-8466
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 PENNOAK LN APT K
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City | GREENSBORO
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State | NC
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Zip | 27407-4097
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Country | US
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Telephone | 919-880-5836
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | JANESHA FAULK
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Credential |
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Telephone | 919-880-5836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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