Provider Demographics
NPI:1215676077
Name:SERENITY AT WOODLANDS
Entity type:Organization
Organization Name:SERENITY AT WOODLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-301-1369
Mailing Address - Street 1:25828 E CALHOUN PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4399
Mailing Address - Country:US
Mailing Address - Phone:720-301-1369
Mailing Address - Fax:
Practice Address - Street 1:1605 WHITETAIL DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2809
Practice Address - Country:US
Practice Address - Phone:720-301-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88-2518706Medicaid