Provider Demographics
NPI:1619242971
Name:SERENITY HOME, LLC
Entity Type:Organization
Organization Name:SERENITY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEDIRA
Authorized Official - Middle Name:ABDURAHMAN
Authorized Official - Last Name:ABUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-787-3239
Mailing Address - Street 1:3111 SKY COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1883
Mailing Address - Country:US
Mailing Address - Phone:775-787-3239
Mailing Address - Fax:
Practice Address - Street 1:3111 SKY COUNTRY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1883
Practice Address - Country:US
Practice Address - Phone:775-787-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV122173320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness