Provider Demographics
NPI:1336557180
Name:SERENITY ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:SERENITY ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-862-3908
Mailing Address - Street 1:15322 MATIS RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-1023
Mailing Address - Country:US
Mailing Address - Phone:727-862-3908
Mailing Address - Fax:727-863-5270
Practice Address - Street 1:15322 MATIS RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-1023
Practice Address - Country:US
Practice Address - Phone:727-862-3908
Practice Address - Fax:727-863-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9407310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility