Provider Demographics
NPI:1841632007
Name:SERENITY ADULT FOSTER CARE HOME LLC
Entity type:Organization
Organization Name:SERENITY ADULT FOSTER CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:BRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-920-8471
Mailing Address - Street 1:2883 S. 41 RD
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-876-1956
Mailing Address - Fax:231-876-1955
Practice Address - Street 1:2883 S. 41 RD.
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-876-1956
Practice Address - Fax:231-876-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL830272541253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9600882Medicaid