Provider Demographics
NPI:1235607854
Name:CSM SERENITY HOMES, LLC
Entity Type:Organization
Organization Name:CSM SERENITY HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-894-1962
Mailing Address - Street 1:1714 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7311
Mailing Address - Country:US
Mailing Address - Phone:616-298-7698
Mailing Address - Fax:616-298-7426
Practice Address - Street 1:1714 W 32ND ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7311
Practice Address - Country:US
Practice Address - Phone:616-298-7698
Practice Address - Fax:616-298-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness