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General NPI Number Information
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NPI Number | 1043024391
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Entity Type | Organization
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Legal Business Name | SERENITY ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 5524 S VENTURA DRIVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73135
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Country | US
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Telephone | 405-627-8552
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Fax | 405-455-1215
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Provider Business Mailing Address
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Address Line | P.O BOX 55811
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City | OKLAHOMA CITY
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State | OK
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Zip | 73155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EVONNDA JEAN FIELDS
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Credential | MSW
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Telephone | 405-627-8552
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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