Provider Demographics
NPI:1487213336
Name:SERENITY SENIOR CARE,INC
Entity Type:Organization
Organization Name:SERENITY SENIOR CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER-BUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-999-1719
Mailing Address - Street 1:126 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1429
Mailing Address - Country:US
Mailing Address - Phone:804-999-1719
Mailing Address - Fax:
Practice Address - Street 1:126 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1429
Practice Address - Country:US
Practice Address - Phone:804-999-1719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY SENIOR CARE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care