Provider Demographics
NPI:1790365708
Name:SERENITY PERSONAL CARE HOME AND
Entity Type:Organization
Organization Name:SERENITY PERSONAL CARE HOME AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:HIBBLER
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:662-347-9230
Mailing Address - Street 1:31 BRITT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2793
Mailing Address - Country:US
Mailing Address - Phone:662-347-9230
Mailing Address - Fax:
Practice Address - Street 1:31 BRITT RD
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2793
Practice Address - Country:US
Practice Address - Phone:662-347-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility