Provider Demographics
NPI:1295551281
Name:SERENE HAVEN RESIDENTIAL
Entity type:Organization
Organization Name:SERENE HAVEN RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-348-3033
Mailing Address - Street 1:19940 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19940 STANLEY ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1869
Practice Address - Country:US
Practice Address - Phone:419-348-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle