Provider Demographics
NPI:1497740211
Name:SERENE MANOR HOSPITAL INC
Entity Type:Organization
Organization Name:SERENE MANOR HOSPITAL INC
Other - Org Name:SERENE MANOR MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-523-9171
Mailing Address - Street 1:970 WRAY STREET
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917
Mailing Address - Country:US
Mailing Address - Phone:865-523-9171
Mailing Address - Fax:865-523-0021
Practice Address - Street 1:970 WRAY STREET
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-523-9171
Practice Address - Fax:865-523-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7440177313M00000X
TN313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN74410177Medicaid
TN744017Medicaid