Provider Demographics
NPI:1699154088
Name:SERENITY FCH #3
Entity type:Organization
Organization Name:SERENITY FCH #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-532-4864
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:HARRELLS
Mailing Address - State:NC
Mailing Address - Zip Code:28444-0377
Mailing Address - Country:US
Mailing Address - Phone:910-532-4864
Mailing Address - Fax:910-532-2766
Practice Address - Street 1:100 WEST LISBON MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-1333
Practice Address - Country:US
Practice Address - Phone:910-532-4864
Practice Address - Fax:910-532-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home