Basic Information
| Provider Information | |||||||||
| NPI: | 1265041446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERENE LIVING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1317 DUPAS ST | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700533710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043191769 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1567 SHIRLEY DR | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701142911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043191769 | ||||||||
| FaxNumber: | 5043837448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2020 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | CHERRELL | ||||||||
| AuthorizedOfficialMiddleName: | LYNETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5043191769 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARM D | ||||||||
| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 310500000X | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness |
No ID Information.