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General NPI Number Information
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NPI Number | 1205983327
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Entity Type | Organization
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Legal Business Name | SERENITY GARDENS, INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 600 LESLIE DR
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City | KERRVILLE
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State | TX
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Zip | 78028-2518
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Country | US
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Telephone | 830-792-6886
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Fax | 830-792-6965
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Provider Business Mailing Address
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Address Line | 600 LESLIE DR
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City | KERRVILLE
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State | TX
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Zip | 78028-2518
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Country | US
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Telephone | 830-792-6886
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Fax | 830-792-6965
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LINDA S. STEWART
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Credential | C.A.L.M.
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Telephone | 830-792-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 000590
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License Number State | TX
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