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NPI Code Detail

MEDICARE: SERENITY ASSISTED LIVING, LLC

MEDICARE: SERENITY ASSISTED LIVING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1385H00000XRespite Care
2311ZA0620XAdult Care Home Facility

General Provider Information

NPI Number : 1043024391
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERENITY ASSISTED LIVING, LLC
Provider Business Mailing Address
First Line : P.O BOX 55811
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5524 S VENTURA DRIVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73135
Country : US
Telephone Number : 405-627-8552
Fax Number : 405-455-1215
Authorized Official
Title or Position : CEO
Name : EVONNDA JEAN FIELDS
Credential : MSW
Telephone Number : 405-627-8552
Provider Enumeration Date : 02/06/2025
Last Update Date : 02/06/2025

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