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General NPI Number Information
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NPI Number | 1326753260
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Entity Type | Organization
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Legal Business Name | SERENITY SENIOR LIVING I, LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 1025 CAVERN DR
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City | MESQUITE
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State | TX
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Zip | 75181-4418
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Country | US
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Telephone | 972-629-9707
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Fax |
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Provider Business Mailing Address
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Address Line | 3349 INTERSTATE 30
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City | MESQUITE
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State | TX
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Zip | 75150-2630
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Country | US
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Telephone | 214-730-0042
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JASON L SHAW
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Credential | LMSW
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Telephone | 214-730-0042
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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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