Provider Demographics
NPI:1972727758
Name:SERENITY HOUSE ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:SERENITY HOUSE ASSISTED LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:ZISLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-584-8926
Mailing Address - Street 1:5290 E YALE CIR STE 209
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6933
Mailing Address - Country:US
Mailing Address - Phone:303-584-8926
Mailing Address - Fax:303-584-9508
Practice Address - Street 1:5290 E YALE CIR STE 209
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6933
Practice Address - Country:US
Practice Address - Phone:303-584-8926
Practice Address - Fax:303-584-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0378310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42377820Medicaid
CO50536788Medicaid
CO57787069Medicaid
CO63581582Medicaid
CO76539873Medicaid
CO09478876Medicaid
CO20728352Medicaid
CO59384735Medicaid
CO18202586Medicaid
CO53278771Medicaid
CO99189542Medicaid
CO50053230Medicaid
CO33037027Medicaid
CO78981824Medicaid
CO95529284Medicaid
CO97354520Medicaid