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General NPI Number Information
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NPI Number | 1508458365
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Entity Type | Organization
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Legal Business Name | SERENITY RESIDENTIAL CARE HOME
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 7307 ISHERWOOD RD
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City | MEMPHIS
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State | TN
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Zip | 38125-2124
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Country | US
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Telephone | 901-603-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 5532 EMERALD HILLS DR
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City | MEMPHIS
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State | TN
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Zip | 38115-4616
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Country | US
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Telephone | 901-603-7741
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. TIFFANY JEANIA ATKINS
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Credential |
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Telephone | 901-603-7741
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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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