Provider Demographics
NPI:1306134184
Name:SERENITY FOUNDATIONS, LLC
Entity type:Organization
Organization Name:SERENITY FOUNDATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ED, CM
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LORIE
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-425-7680
Mailing Address - Street 1:44 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6242
Mailing Address - Country:US
Mailing Address - Phone:606-425-7680
Mailing Address - Fax:606-425-5330
Practice Address - Street 1:128 BRIANS WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6151
Practice Address - Country:US
Practice Address - Phone:606-416-5279
Practice Address - Fax:606-425-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities