Provider Demographics
NPI:1639353881
Name:SERENITY MEADOWS CARE CENTER CORPORATION
Entity Type:Organization
Organization Name:SERENITY MEADOWS CARE CENTER CORPORATION
Other - Org Name:SERENITY MEADOWS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEIZO
Authorized Official - Middle Name:DEVOTNAE
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:682-561-3889
Mailing Address - Street 1:2300 CAMP DR
Mailing Address - Street 2:APT 1103
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-2005
Mailing Address - Country:US
Mailing Address - Phone:682-561-3889
Mailing Address - Fax:432-756-2904
Practice Address - Street 1:2300 CAMP DR
Practice Address - Street 2:APT 1103
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-2005
Practice Address - Country:US
Practice Address - Phone:682-561-3889
Practice Address - Fax:432-756-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility