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General NPI Number Information
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NPI Number | 1912494246
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Entity Type | Organization
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Legal Business Name | SERENITY RESIDENTIAL SERVICES INC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 2406 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2002
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Country | US
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Telephone | 904-379-8914
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Fax | 904-800-1465
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Provider Business Mailing Address
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Address Line | 2406 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2002
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Country | US
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Telephone | 904-379-8914
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Fax | 904-800-1465
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. LAUREN ASHLEE THOMAS
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Credential |
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Telephone | 904-379-8914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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License Number State | FL
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