Provider Demographics
NPI:1265862031
Name:SERENITY MANOR AGENCY
Entity Type:Organization
Organization Name:SERENITY MANOR AGENCY
Other - Org Name:SERENITY MANOR AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TENEMA
Authorized Official - Middle Name:RACHAE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-965-3748
Mailing Address - Street 1:322 REGAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3638
Mailing Address - Country:US
Mailing Address - Phone:813-315-8894
Mailing Address - Fax:813-315-9358
Practice Address - Street 1:322 REGAL PARK DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3638
Practice Address - Country:US
Practice Address - Phone:813-315-8894
Practice Address - Fax:813-315-9358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY MANOR ASSISTED LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care