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General NPI Number Information
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NPI Number | 1699154088
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Entity Type | Organization
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Legal Business Name | SERENITY FCH #3
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 100 WEST LISBON MAGNOLIA RD
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City | ROSE HILL
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State | NC
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Zip | 28458-1333
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Country | US
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Telephone | 910-532-4864
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Fax | 910-532-2766
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Provider Business Mailing Address
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Address Line | PO BOX 377
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City | HARRELLS
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State | NC
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Zip | 28444-0377
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Country | US
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Telephone | 910-532-4864
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Fax | 910-532-2766
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Authorized Official
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Title or Position | OWNER
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Name | ERICA FENNELL
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Credential |
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Telephone | 910-532-4864
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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 |
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License Number State |
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