Provider Demographics
NPI:1558052001
Name:HEARTS OF SERENITY HOMES, INC.
Entity Type:Organization
Organization Name:HEARTS OF SERENITY HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NETRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-297-2737
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:CLARCONA
Mailing Address - State:FL
Mailing Address - Zip Code:32710-0705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6436 SWALLOW HILL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-2221
Practice Address - Country:US
Practice Address - Phone:321-297-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities