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General NPI Number Information
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NPI Number | 1194014001
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Entity Type | Organization
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Legal Business Name | SERENIY FAMILY CARE HOME
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 1436 BLAND SCHOOL RD
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City | HARRELLS
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State | NC
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Zip | 28444-7609
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Country | US
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Telephone | 910-532-4805
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Fax | 910-532-2766
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Provider Business Mailing Address
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Address Line | PO BOX 377
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City | HARRELLS
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State | NC
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Zip | 28444-0377
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Country | US
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Telephone | 910-532-4805
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Fax | 910-532-2766
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ERICA TERESA FENNELL
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Credential |
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Telephone | 910-337-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | FCH-082-017
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCH-082-017
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License Number State | NC
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