Provider Demographics
NPI:1780717660
Name:SERENITY HOME INC.
Entity type:Organization
Organization Name:SERENITY HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-240-9574
Mailing Address - Street 1:2 ALBERTA LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1864
Mailing Address - Country:US
Mailing Address - Phone:774-213-5880
Mailing Address - Fax:774-213-5043
Practice Address - Street 1:98 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2123
Practice Address - Country:US
Practice Address - Phone:508-947-2155
Practice Address - Fax:508-946-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8533104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5508789Medicaid