Provider Demographics
NPI:1548802937
Name:SERENITY ADULT DAY HEALTH, INC
Entity Type:Organization
Organization Name:SERENITY ADULT DAY HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-714-0246
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-0947
Mailing Address - Country:US
Mailing Address - Phone:478-714-0246
Mailing Address - Fax:
Practice Address - Street 1:95 TRUMAN RD
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-4643
Practice Address - Country:US
Practice Address - Phone:478-714-0246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care