Provider Demographics
NPI:1548799216
Name:SERENITY HOMES-NORTH
Entity Type:Organization
Organization Name:SERENITY HOMES-NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-550-6411
Mailing Address - Street 1:3109 LAWTON DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2916
Mailing Address - Country:US
Mailing Address - Phone:616-361-6571
Mailing Address - Fax:616-361-0852
Practice Address - Street 1:830 HAYES STREET
Practice Address - Street 2:
Practice Address - City:MARNE
Practice Address - State:MI
Practice Address - Zip Code:49435
Practice Address - Country:US
Practice Address - Phone:616-677-6015
Practice Address - Fax:616-431-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home