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General NPI Number Information
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NPI Number | 1194908400
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Entity Type | Organization
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Legal Business Name | SERENITY HOUSE ADULT DAY HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 511 N. CHURCH STREET
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2709
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Country | US
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Telephone | 601-833-4166
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 1334
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City | BROOKHAVEN
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State | MS
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Zip | 39601
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Country | US
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Telephone | 601-833-4166
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KATHERINE RICHARDSON
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Credential |
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Telephone | 601-833-4166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 887539
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 887539
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 887539
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License Number State | MS
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