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General NPI Number Information
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NPI Number | 1912266396
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Entity Type | Organization
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Legal Business Name | SERENITY CARE WITH LOVE, LLC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 1205 B 8 CROSSCREEK CIRCLE
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City | GREENVILLE
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State | NC
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Zip | 27834
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Country | US
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Telephone | 804-301-5920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30202
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City | GREENVILLE
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State | NC
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Zip | 27833-0202
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Country | US
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Telephone | 804-301-5920
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TAMIKA RENEE GROVES
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Credential |
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Telephone | 804-301-5920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-074-238
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License Number State | NC
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