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General NPI Number Information
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NPI Number | 1265071153
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Entity Type | Organization
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Legal Business Name | SERENITY HILL ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 12/25/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 3534 230TH TER
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City | LAKE CITY
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State | FL
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Zip | 32024-2714
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Country | US
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Telephone | 850-363-9306
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Fax | 855-326-8575
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Provider Business Mailing Address
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Address Line | 3534 230TH TER
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City | LAKE CITY
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State | FL
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Zip | 32024-2714
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Country | US
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Telephone | 850-363-9306
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Fax | 855-326-8575
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Authorized Official
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Title or Position | OWNER
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Name | LATASHA T GRAHAM
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Credential |
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Telephone | 386-754-8889
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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 |
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License Number State |
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