Provider Demographics
NPI:1619424504
Name:SERENITYS WAY
Entity Type:Organization
Organization Name:SERENITYS WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:ILER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:1330-271-9817
Mailing Address - Street 1:11557 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8621
Mailing Address - Country:US
Mailing Address - Phone:330-271-9338
Mailing Address - Fax:
Practice Address - Street 1:11557 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8621
Practice Address - Country:US
Practice Address - Phone:330-271-9817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7609010251C00000X
251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114960Medicaid