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General NPI Number Information
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NPI Number | 1831783216
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Entity Type | Organization
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Legal Business Name | SERENITY HOUSE LLC
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 5421 STONE LN
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City | RICHMOND
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State | VA
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Zip | 23227-2647
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Country | US
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Telephone | 804-405-9743
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Fax | 866-681-2172
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Provider Business Mailing Address
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Address Line | 4932 CEDAR SUMMIT RD
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City | RICHMOND
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State | VA
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Zip | 23223-2890
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Country | US
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Telephone | 804-405-9743
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/PROGRAM DIR
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Name | YVETTE ALLEN-TATUM
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Credential |
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Telephone | 804-405-9743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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