Provider Demographics
NPI:1407601768
Name:SERENITY SUITES LLC
Entity Type:Organization
Organization Name:SERENITY SUITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VONDALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-447-9639
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-0372
Mailing Address - Country:US
Mailing Address - Phone:813-939-7003
Mailing Address - Fax:813-333-1433
Practice Address - Street 1:1757 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-1820
Practice Address - Country:US
Practice Address - Phone:813-939-7003
Practice Address - Fax:813-333-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)