Provider Demographics
NPI:1881992147
Name:SERENITY HOME CORPORATION INC.
Entity type:Organization
Organization Name:SERENITY HOME CORPORATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORALES-MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-827-2473
Mailing Address - Street 1:511 S BLOODWORTH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1947
Mailing Address - Country:US
Mailing Address - Phone:919-900-8514
Mailing Address - Fax:919-900-8514
Practice Address - Street 1:511 S BLOODWORTH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1947
Practice Address - Country:US
Practice Address - Phone:919-900-8514
Practice Address - Fax:919-900-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-809311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC092809Medicaid