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General NPI Number Information
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NPI Number | 1841632007
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Entity Type | Organization
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Legal Business Name | SERENITY ADULT FOSTER CARE HOME LLC
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 2883 S. 41 RD.
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City | CADILLAC
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-876-1956
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Fax | 231-876-1955
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Provider Business Mailing Address
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Address Line | 2883 S. 41 RD
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City | CADILLAC
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-876-1956
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Fax | 231-876-1955
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA LORAINE BRUNI
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Credential |
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Telephone | 231-920-8471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | AL830272541
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License Number State | MI
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