Provider Demographics
NPI:1073340584
Name:SERENITY HOPE FAMILY CENTER
Entity type:Organization
Organization Name:SERENITY HOPE FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JALEN
Authorized Official - Last Name:BONANNEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-593-0886
Mailing Address - Street 1:5040 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3222
Mailing Address - Country:US
Mailing Address - Phone:954-593-0886
Mailing Address - Fax:
Practice Address - Street 1:5040 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-3222
Practice Address - Country:US
Practice Address - Phone:954-593-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)