Provider Demographics
NPI:1821194788
Name:SERRA RETIREMENT CENTER INC
Entity Type:Organization
Organization Name:SERRA RETIREMENT CENTER INC
Other - Org Name:FIVE STAR CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-723-2230
Mailing Address - Street 1:100 SERRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-5369
Mailing Address - Fax:304-723-3849
Practice Address - Street 1:100 SERRA DRIVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-5369
Practice Address - Fax:304-723-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV024038251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4704002000Medicaid