Provider Demographics
NPI:1811473291
Name:SERENITY RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:SERENITY RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-835-5280
Mailing Address - Street 1:PO BOX 10913
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-6913
Mailing Address - Country:US
Mailing Address - Phone:207-835-5280
Mailing Address - Fax:
Practice Address - Street 1:570 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2357
Practice Address - Country:US
Practice Address - Phone:207-615-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME253Z00000XOtherIN-HOME SUPPORT CARE
ME253Z00000XOtherIN-HOME SUPPORT CARE