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General NPI Number Information
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NPI Number | 1235607854
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Entity Type | Organization
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Legal Business Name | CSM SERENITY HOMES, LLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 1714 W 32ND ST
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City | HOLLAND
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State | MI
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Zip | 49423-7311
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Country | US
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Telephone | 616-298-7698
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Fax | 616-298-7426
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Provider Business Mailing Address
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Address Line | 1714 W 32ND ST
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City | HOLLAND
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State | MI
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Zip | 49423-7311
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Country | US
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Telephone | 616-298-7698
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Fax | 616-298-7426
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNY CLARK
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Credential |
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Telephone | 616-894-1962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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