Provider Demographics
NPI:1235358961
Name:SERENITY HOUSE
Entity Type:Organization
Organization Name:SERENITY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EMAFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-238-9449
Mailing Address - Street 1:309 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6311
Mailing Address - Country:US
Mailing Address - Phone:704-238-9449
Mailing Address - Fax:704-238-8449
Practice Address - Street 1:309 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6311
Practice Address - Country:US
Practice Address - Phone:704-238-9449
Practice Address - Fax:704-238-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-090-114OtherDFS LICENSE NUMBER