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General NPI Number Information
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NPI Number | 1811473291
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Entity Type | Organization
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Legal Business Name | SERENITY RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 570 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2357
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Country | US
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Telephone | 207-615-7144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10913
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City | PORTLAND
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State | ME
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Zip | 04104-6913
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Country | US
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Telephone | 207-835-5280
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES DIRECTOR
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Name | MAGDA DARLING
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Credential |
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Telephone | 207-835-5280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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