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General NPI Number Information
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NPI Number | 1164752150
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Entity Type | Organization
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Legal Business Name | SERENITY SPRINGS PERSONAL CARE HOME INC.
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 4838 MILL CREEK RD
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City | STATESBORO
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State | GA
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Zip | 30461-7716
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Country | US
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Telephone | 912-587-3549
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Fax | 912-587-9597
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Provider Business Mailing Address
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Address Line | 4838 MILL CREEK RD
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City | STATESBORO
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State | GA
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Zip | 30461-7716
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Country | US
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Telephone | 912-587-3549
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Fax | 912-587-9597
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MRS. EDNA MOZELLE LOVETT
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Credential | RN
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Telephone | 912-587-3549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 016010511
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License Number State | GA
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