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General NPI Number Information
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NPI Number | 1821806068
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Entity Type | Organization
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Legal Business Name | SERENITY REHABILITATION AND THERAPY, LLC.
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 3405 SWEETWATER RD 422
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3004
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Country | US
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Telephone | 561-889-8812
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Fax |
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Provider Business Mailing Address
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Address Line | 3405 SWEETWATER RD 422
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3004
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Country | US
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Telephone | 561-889-8812
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Fax |
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Authorized Official
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Title or Position | CEO/MEMBER
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Name | MISS NISHELLE ANTOINETTE THIMOTE-HERALDO
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Credential | OTR
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Telephone | 561-889-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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