Provider Demographics
NPI:1679323323
Name:SERENITY WOODS , LLC
Entity Type:Organization
Organization Name:SERENITY WOODS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:NAR
Authorized Official - Phone:206-778-9199
Mailing Address - Street 1:218 MAIN ST # 308
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6108
Mailing Address - Country:US
Mailing Address - Phone:206-778-9199
Mailing Address - Fax:
Practice Address - Street 1:14413 SALAL DR
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3654
Practice Address - Country:US
Practice Address - Phone:425-741-1224
Practice Address - Fax:425-741-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home