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General NPI Number Information
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NPI Number | 1609356732
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Entity Type | Organization
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Legal Business Name | WISNA SERENITY HOMES CORP
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 444 NORTH MOUNT VERNON AVE
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-504-9217
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Fax |
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Provider Business Mailing Address
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Address Line | 444 NORTH MOUNTH VERNON AVE
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City | POTTSTOWN
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State | PA
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Zip | 19464-0411
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Country | US
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Telephone | 610-504-9217
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Fax | 610-926-4086
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Authorized Official
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Title or Position | CEO
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Name | WISNADA DORESTAN
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Credential | RN/MSN/FNP
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Telephone | 610-504-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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