Provider Demographics
NPI:1174834261
Name:SERENITY HEART FAMILY CARE HOME,LLC
Entity Type:Organization
Organization Name:SERENITY HEART FAMILY CARE HOME,LLC
Other - Org Name:SERENITY HEART FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENNEA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-713-2420
Mailing Address - Street 1:441 N LOUISIANA AVE STE O
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3791
Mailing Address - Country:US
Mailing Address - Phone:828-505-8005
Mailing Address - Fax:
Practice Address - Street 1:230 COUNTRY TIME LN
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-6213
Practice Address - Country:US
Practice Address - Phone:828-683-9883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility