SERENITY PERSONAL CARE RESIDENCE (NPI# 1083880629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083880629 |
| Entity Type | Organization |
| Organization Name | SERENITY PERSONAL CARE RESIDENCE |
| Practice Address |
2327 Young Rd Stone Mountain GA 30088-4111 |
| Mailing Address |
5506 Stoneleigh Ct Stone Mountain GA 30088-3433 |
| Practice Telephone | 6789080921 |
| Mailing Telephone | 6789080921 |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2008-05-04 |
| Authorized Official Name | MR. ALMON THOMPSON (OWNER ADMINISTRATOR) |
| Authorized Official Telephone | 6789080921 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
044-01716-9 | GA | Nursing & Custodial Care Facilities |
| Street Address |
2327 YOUNG RD |
| City | STONE MOUNTAIN |
| State | GA |
| Zip Code | 30088-4111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565902 | Edward Edeh | Pharmacist | 1232 South Hairstoh Road, Stone Mountain, GA 30088 | 2020-10-16 |
| 1588124879 | Birds of Paradise Physical Therapy Services,llc | Physical Therapy Assistant | 754 Post Road Ln, Address Line 2, Stone Mountain, GA 30088 | 2019-03-22 |
| 1710467923 | Stephanie Patrice Mccray | In Home Supportive Care | 1058 Millard Road, Stone Mountain, GA 30088 | 2018-08-16 |
| 1912365321 | Audrey Perry | Respiratory Therapist, Certified | 1588 Linkview Close, Stone Mountain, GA 30088 | 2016-02-01 |
| 1689041428 | Reaching Above Poverty | Counselor | 5401 Megan Rd, Stone Mountain, GA 30088 | 2015-08-27 |
| 1043692254 | Bethany Johnson | Home Health Aide | 981 Deer Chase Court, Stone Mountain, GA 30088 | 2015-06-24 |
| 1073859666 | Whitney's Place Inc. | Custodial Care Facility | 5451 Rockbeidge Road, Stone Mountain, GA 30088 | 2012-12-31 |
| 1831468818 | The Art of Living Cla LLC. | Community/Behavioral Health | 1668 South Hairston Rd, Stone Mountain, GA 30088 | 2011-12-21 |
| 1659670792 | Atarah Ranit Kimmons | Occupational Therapist | 2045 County Down Lane, Stone Moutain, GA 30088 | 2011-03-15 |
| 1104060219 | William Tyrell Reid Jr. | Dentist | 1183 South Hairstron Rd., Suite D, Stone Mountain, GA 30088 | 2009-04-21 |
| Find all providers in zip 30088 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356984041 | Manuel Carl Mckenzie IIi | Custodial Care Facility | 4893 Candlewood Ln, Stone Mountain, GA 30088-1605 | 2019-10-24 |
| 1841624095 | Peaceful Love & Care | Custodial Care Facility | 815 Pine Roc Dr, Stone Mountain, GA 30083-3521 | 2013-08-23 |
| 1073859666 | Whitney's Place Inc. | Custodial Care Facility | 5451 Rockbeidge Road, Stone Mountain, GA 30088 | 2012-12-31 |
| 1609010651 | Affordable Property Management Inc | Custodial Care Facility | 724 Trigg Lake Ct, Stone Mountain, GA 30087-6529 | 2009-04-21 |
| 1588859359 | Betty Family Advocate Group | Custodial Care Facility | 6505 Battery Pt, Stone Mountain, GA 30087-4646 | 2007-09-13 |
| 1881924892 | Lgd Psychological Services | Custodial Care Facility | 5438 Redwood Ct, Stone Mountain, GA 30087-5758 | 2010-01-14 |
| 1336304799 | L G D Psychological Services, LLC | Custodial Care Facility | 5438 Redwood Ct, Stone Mountain, GA 30087-5758 | 2008-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174437 | United Hands Support Services | Custodial Care Facility | 735 Ridge Rd, Canton, GA 30114-4170 | 2020-11-06 |
| 1679174429 | Golden Peak Senior Living Corp | Custodial Care Facility | 411 Edmond St, Calhoun, GA 30701-5334 | 2020-11-06 |
| 1023615531 | Lillian Womble | Custodial Care Facility | 3232 Union Church Road, Warthen, GA 31094 | 2020-10-07 |
| 1750995155 | Jacqueline Dingle | Custodial Care Facility | 604 Sugarbush Cir, Savannah, GA 31406-4434 | 2020-09-02 |
| 1114549763 | Idella's Angels | Custodial Care Facility | 270 13th Ave Sw, Cairo, GA 39828-3423 | 2020-05-16 |
| 1356962062 | Brendas Love Personal Care Home LLC | Custodial Care Facility | 8239 Queens Dr, Jonesboro, GA 30238-2946 | 2020-05-04 |
| 1801421094 | Lj's Personal Care Home, LLC | Custodial Care Facility | 415 E 18th St Sw, Rome, GA 30161-6544 | 2020-03-08 |
| 1457904310 | Renaissance Healthcare LLC | Custodial Care Facility | 419 Airport Rd, Griffin, GA 30224-4834 | 2019-07-19 |
| 1225697873 | Tahirah Johnston | Custodial Care Facility | 1657 Hallmark Hills Dr, Griffin, GA 30223-8790 | 2019-06-07 |
| 1508420613 | Rosa Amanda Hill | Custodial Care Facility | 1073 Davis Rd, Culloden, GA 31016-5843 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
| City | STONE MOUNTAIN |
| Zip Code | 30088 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.