Provider Demographics
NPI:1588897409
Name:SERENITY ASSISTED LIVING
Entity type:Organization
Organization Name:SERENITY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MOUNIRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUAITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-247-2343
Mailing Address - Street 1:11328 N BRAY RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-7954
Mailing Address - Country:US
Mailing Address - Phone:810-247-2343
Mailing Address - Fax:810-670-6767
Practice Address - Street 1:11328 N BRAY RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-7954
Practice Address - Country:US
Practice Address - Phone:810-247-2343
Practice Address - Fax:810-670-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250299205320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities