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General NPI Number Information
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NPI Number | 1871028530
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Entity Type | Organization
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Legal Business Name | SERENE JOURNEY ASSISTED LIVING FACILITY LLC.
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1111 BLALOCK RD APT 32
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City | HOUSTON
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State | TX
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Zip | 77055-7426
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Country | US
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Telephone | 832-449-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 BLALOCK RD APT 32
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City | HOUSTON
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State | TX
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Zip | 77055-7426
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Country | US
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Telephone | 832-449-6470
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | STACIE ANN SHAKIR
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Credential |
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Telephone | 832-449-6470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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