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General NPI Number Information
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NPI Number | 1548397797
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Entity Type | Organization
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Legal Business Name | SERENITY INCORPORATED
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1002 WILSHIRE DR
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City | CARY
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State | NC
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Zip | 27511-3921
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Country | US
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Telephone | 919-771-9173
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Fax | 919-367-0816
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Provider Business Mailing Address
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Address Line | PO BOX 1583
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City | CARY
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State | NC
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Zip | 27512-1583
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Country | US
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Telephone | 919-771-9173
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Fax | 919-367-0816
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CLARICE SHYLLON FAULKNER
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Credential | RN
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Telephone | 919-771-9173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-092-501
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License Number State | NC
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