Provider Demographics
NPI:1811201072
Name:SERENITY SHELTERING ARMS PCH
Entity Type:Organization
Organization Name:SERENITY SHELTERING ARMS PCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-789-7655
Mailing Address - Street 1:4750 TARA CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2025
Mailing Address - Country:US
Mailing Address - Phone:404-241-5251
Mailing Address - Fax:404-241-5349
Practice Address - Street 1:4750 TARA CREEK TRL
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2025
Practice Address - Country:US
Practice Address - Phone:404-241-5251
Practice Address - Fax:404-241-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-01-733-1251G00000X
GA044-01-897-9251G00000X
GA044-01-917-9251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based