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General NPI Number Information
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NPI Number | 1669919387
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Entity Type | Organization
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Legal Business Name | LIFETIME SERENITY ASSISTED LIVING
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 8507 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4833
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Country | US
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Telephone | 410-496-9105
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Fax | 410-496-9109
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Provider Business Mailing Address
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Address Line | 3304 MENLO DR
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City | BALTIMORE
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State | MD
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Zip | 21215-3826
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Country | US
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Telephone | 410-358-4401
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Fax | 410-358-4402
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DONOVAN PARKES
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Credential | MD
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Telephone | 410-428-1382
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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 | 30AL3431-A
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License Number State | MD
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