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General NPI Number Information
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NPI Number | 1205727708
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Entity Type | Organization
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Legal Business Name | SERENITY HAVEN SUPPORT
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 1213 FOX CREEK DR
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City | KILLEEN
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State | TX
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Zip | 76543-7142
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Country | US
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Telephone | 757-751-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 FOX CREEK DR
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City | KILLEEN
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State | TX
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Zip | 76543-7142
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Country | US
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Telephone | 757-751-7728
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Fax |
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Authorized Official
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Title or Position | OWNER/EX. DIRECTOR
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Name | KHAALIQ RASHEED PAYNE
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Credential |
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Telephone | 757-751-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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