Provider Demographics
NPI:1821551987
Name:SERENE LIVING SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SERENE LIVING SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:TAURAI
Authorized Official - Last Name:MUGOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-467-9256
Mailing Address - Street 1:152 E HIGH ST STE 440B
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5400
Mailing Address - Country:US
Mailing Address - Phone:267-467-9256
Mailing Address - Fax:610-340-4001
Practice Address - Street 1:152 E HIGH ST STE 440B
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5400
Practice Address - Country:US
Practice Address - Phone:267-467-9256
Practice Address - Fax:610-340-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037631950001Medicaid