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General NPI Number Information
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NPI Number | 1093381550
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Entity Type | Organization
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Legal Business Name | A'DIAR SERENITY HOUSE, LLC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 21625 CHAGRIN BLVD STE 100
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City | BEACHWOOD
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State | OH
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Zip | 44122-5335
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Country | US
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Telephone | 216-856-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 21625 CHAGRIN BLVD STE 100
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City | BEACHWOOD
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State | OH
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Zip | 44122-5335
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Country | US
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Telephone | 216-856-3752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SONYA CALLOWAY
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Credential |
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Telephone | 216-856-3752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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