Provider Demographics
NPI:1073805362
Name:SERENITY WAY ASSISTED LIVING
Entity Type:Organization
Organization Name:SERENITY WAY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:POITIER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:561-629-7450
Mailing Address - Street 1:1120 48TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2302
Mailing Address - Country:US
Mailing Address - Phone:561-629-7450
Mailing Address - Fax:561-629-7452
Practice Address - Street 1:1120 48TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2302
Practice Address - Country:US
Practice Address - Phone:561-629-7450
Practice Address - Fax:561-629-7452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL117133104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001708200Medicaid