Provider Demographics
NPI:1003289406
Name:SERENITY LIVING CENTER
Entity Type:Organization
Organization Name:SERENITY LIVING CENTER
Other - Org Name:SERENITY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-477-7254
Mailing Address - Street 1:1125 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 OAKVIEW DR
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1827
Practice Address - Country:US
Practice Address - Phone:218-477-7254
Practice Address - Fax:218-477-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN372061310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM183447400OtherUMPI
MNM559433000OtherUMPI