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General NPI Number Information
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NPI Number | 1902620610
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Entity Type | Organization
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Legal Business Name | HOUSE OF SERINITY
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Dates
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Enumeration Date | 11/09/2024
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 4076 BONFIELD DR
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City | MONTGOMERY
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State | AL
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Zip | 36116-4838
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Country | US
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Telephone | 334-655-4175
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 BONFIELD CT
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City | MONTGOMERY
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State | AL
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Zip | 36116-4819
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Country | US
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Telephone | 334-655-4175
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAKISHA EDWARDS
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Credential |
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Telephone | 334-655-4175
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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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