Provider Demographics
NPI:1871028530
Name:SERENE JOURNEY ASSISTED LIVING FACILITY LLC.
Entity Type:Organization
Organization Name:SERENE JOURNEY ASSISTED LIVING FACILITY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-449-6470
Mailing Address - Street 1:1111 BLALOCK RD APT 32
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7426
Mailing Address - Country:US
Mailing Address - Phone:832-449-6470
Mailing Address - Fax:
Practice Address - Street 1:1111 BLALOCK RD APT 32
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7426
Practice Address - Country:US
Practice Address - Phone:832-449-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No251E00000XAgenciesHome Health