Provider Demographics
NPI:1841563723
Name:SERENITY ADULT LIVING, LLC
Entity Type:Organization
Organization Name:SERENITY ADULT LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-375-6464
Mailing Address - Street 1:5601 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3224
Mailing Address - Country:US
Mailing Address - Phone:516-375-6464
Mailing Address - Fax:520-514-9394
Practice Address - Street 1:5601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3224
Practice Address - Country:US
Practice Address - Phone:516-375-6464
Practice Address - Fax:520-514-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3014380310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility