Provider Demographics
NPI:1174681944
Name:SERENITY PERSONAL CARE HOME
Entity Type:Organization
Organization Name:SERENITY PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAKELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-923-6654
Mailing Address - Street 1:7070 BOWIE DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7527
Mailing Address - Country:US
Mailing Address - Phone:770-696-1299
Mailing Address - Fax:770-728-9016
Practice Address - Street 1:7070 BOWIE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-7527
Practice Address - Country:US
Practice Address - Phone:770-696-1299
Practice Address - Fax:770-728-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility