Provider Demographics
NPI:1609356732
Name:WISNA SERENITY HOMES CORP
Entity Type:Organization
Organization Name:WISNA SERENITY HOMES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WISNADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORESTAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN/MSN/FNP
Authorized Official - Phone:610-504-9217
Mailing Address - Street 1:444 NORTH MOUNTH VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-0411
Mailing Address - Country:US
Mailing Address - Phone:610-504-9217
Mailing Address - Fax:610-926-4086
Practice Address - Street 1:444 NORTH MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-504-9217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health