Provider Demographics
NPI:1932928777
Name:SERENITY EMPIRE AT EAST POINT
Entity type:Organization
Organization Name:SERENITY EMPIRE AT EAST POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPRESS
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-875-5064
Mailing Address - Street 1:3409 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5390 YEAGER RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4850
Practice Address - Country:US
Practice Address - Phone:770-875-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility