Provider Demographics
NPI:1871249136
Name:SERENE HOMESTEAD, LLC
Entity Type:Organization
Organization Name:SERENE HOMESTEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:DADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-449-9418
Mailing Address - Street 1:12606 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2923
Mailing Address - Country:US
Mailing Address - Phone:240-449-9418
Mailing Address - Fax:301-768-4495
Practice Address - Street 1:12606 MEADOWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2923
Practice Address - Country:US
Practice Address - Phone:240-449-9418
Practice Address - Fax:301-768-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility