Provider Demographics
NPI:1346598380
Name:SERENE ADULT CARE
Entity Type:Organization
Organization Name:SERENE ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE ATTENDANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ALMEDIA
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-336-2182
Mailing Address - Street 1:P.O BOX 684
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482
Mailing Address - Country:US
Mailing Address - Phone:601-336-2182
Mailing Address - Fax:858-736-2182
Practice Address - Street 1:261 H.R. WATTS RD
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482
Practice Address - Country:US
Practice Address - Phone:601-336-2182
Practice Address - Fax:858-736-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0380803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty