MEDICARE: SERENITY LIFE

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
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1083755896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY LIFE

Provider Business Mailing Address
First Line	:	312 E FRANKLIN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-2911
Country	:	US
Telephone Number	:	208-895-8822
Fax Number	:	208-884-4116

Provider Business Practice Location Address
First Line	:	312 E FRANKLIN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-2911
Country	:	US
Telephone Number	:	208-895-8822
Fax Number	:	208-884-4116

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MRS. TERESA LORENZEN MEEKS
Credential	:
Telephone Number	:	208-895-8822

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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Directions to “SERENITY LIFE ” Practice Location

Language	Start Address	Practice Location

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