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General NPI Number Information
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NPI Number | 1366673063
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Entity Type | Organization
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Legal Business Name | SERENITY HEALTHCARE LLC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 10 BRENWAY DR
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City | WEST HARTFORD
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State | CT
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Zip | 06117-3054
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Country | US
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Telephone | 860-206-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BRENWAY DR
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City | WEST HARTFORD
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State | CT
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Zip | 06117-3054
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Country | US
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Telephone | 860-206-8346
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KANDI HAMLIN OBRIEN
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Credential | APRN
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Telephone | 860-206-8346
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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 | 003877
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 003877
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License Number State | CT
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