Provider Demographics
NPI:1982107678
Name:SERENITY LIFESTYLE PLUS II
Entity Type:Organization
Organization Name:SERENITY LIFESTYLE PLUS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-438-2866
Mailing Address - Street 1:178 EVERGREEN ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1905
Mailing Address - Country:US
Mailing Address - Phone:321-914-3006
Mailing Address - Fax:321-914-3006
Practice Address - Street 1:178 EVERGREEN ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1905
Practice Address - Country:US
Practice Address - Phone:321-914-3006
Practice Address - Fax:321-914-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility