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General NPI Number Information
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NPI Number | 1447686381
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Entity Type | Organization
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Legal Business Name | SERENITY HOMES-NORTH
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 830 HAYES ST
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City | MARNE
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State | MI
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Zip | 49435-9792
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Country | US
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Telephone | 616-677-6015
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Fax | 616-431-5021
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Provider Business Mailing Address
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Address Line | 3109 LAWTON DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-2916
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Country | US
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Telephone | 616-361-6571
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Fax | 616-361-0852
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. ABRAHAM, JOSHUA
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Credential | M.P.A.
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Telephone | 616-361-6571
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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 | AL700316956
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License Number State | MI
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