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General NPI Number Information
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NPI Number | 1700758877
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Entity Type | Organization
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Legal Business Name | SERENITY HOME PLUS LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1609 N RUTGERS ST
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City | WICHITA
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State | KS
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Zip | 67212-1164
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Country | US
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Telephone | 316-399-5479
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Fax |
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Provider Business Mailing Address
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Address Line | 7964 E CARIBOU PL
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City | BEL AIRE
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State | KS
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Zip | 67226-7674
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Country | US
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Telephone |
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Fax | 316-333-7961
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Authorized Official
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Title or Position | OPERATOR/RN
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Name | MARY SAMBOU
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Credential | RN
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Telephone | 316-399-5479
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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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