Provider Demographics
NPI:1316483928
Name:SERENITY REST HOME LLC
Entity type:Organization
Organization Name:SERENITY REST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDELIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-733-5159
Mailing Address - Street 1:98 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2123
Mailing Address - Country:US
Mailing Address - Phone:508-947-2155
Mailing Address - Fax:
Practice Address - Street 1:91 NARROWS RD
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1612
Practice Address - Country:US
Practice Address - Phone:617-733-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1333310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility