SERENITY RESIDENTIAL SERVICES INC (NPI# 1912494246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912494246 |
| Entity Type | Organization |
| Organization Name | SERENITY RESIDENTIAL SERVICES INC |
| Practice Address |
2406 University Blvd W Jacksonville FL 32217-2002 |
| Practice Telephone | 9043798914 |
| Practice Fax Number | 9048001465 |
| Mailing Telephone | 9043798914 |
| Mailing Fax Number | 9048001465 |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |
| Authorized Official Name | MRS. LAUREN ASHLEE THOMAS (VICE PRESIDENT) |
| Authorized Official Telephone | 9043798914 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103K00000X | Behavioral Analyst | FL | Behavioral Health & Social Service Providers | |
| N | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers | ||
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
Respite Care Facility | ||
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | FL | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 010423200 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SERENITY RESIDENTIAL SERVICES INC | 251 Ne 160th Ave, Portland, OR 97230 |
| Street Address |
2406 UNIVERSITY BLVD W |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32217-2002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336605005 | Mary Ellen Mccullough-list | Behavior Technician | 3437 Miruelo Circle North, Jacksonville, FL 32217 | 2019-02-18 |
| 1285131656 | Priority One Home Care LLC | In Home Supportive Care | 7500 Powers Ave Apt 198, Jacksonville, FL 32217 | 2018-04-11 |
| 1407361272 | Sharon Williams | Home Health | 8300 Plaza Gate Lane #1152, Jacksonville, FL 32217 | 2017-12-02 |
| 1548779929 | Acumed Medical Ltd. | Durable Medical Equipment & Medical Supplies | 6653 Powers Avenue, Suite 134, Jacksonville, FL 32217 | 2017-09-28 |
| 1437685526 | Ward Zeigler | Behavior Technician | 3437 Miruelo Cr. N., Jacksonville, FL 32217 | 2017-05-10 |
| 1538695754 | Shilonda Peterson-jackson | Technician, Other | 3437 Miruelo Cr N, Jacksonville, FL 32217 | 2017-05-08 |
| 1114467834 | Louis R. Lothman | Counselor | 3734 San Viscaya Dr., Jacksonville, FL 32217 | 2017-02-28 |
| 1023490141 | A Gentle Touch Home Health Care LLC. | Home Health | 5991 Chester Avenue, Jacksonville, FL 32217 | 2015-06-25 |
| 1912320334 | Christopher Marshall Fuller | Developmental Therapist | 5132 Edgeware Ct., Jacksonville, FL 32217 | 2014-01-22 |
| 1790040020 | Maria R. Tapia | Psychologist | 7680 Smullian Trail West, Jacksonville, FL 32217 | 2012-07-12 |
| Find all providers in zip 32217 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184932956 | L'arche Harbor House, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 700 Arlington Rd N, Jacksonville, FL 32211-7306 | 2010-09-15 |
| 1649426065 | Marjorie G. Cupp | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1545 Parkwood St, Jacksonville, FL 32207-5476 | 2008-08-18 |
| 1447382387 | Houseofdavid | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 209 Toni Dr, Jacksonville, NC 28546-4803 | 2007-03-09 |
| 1528198892 | Hampton Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 100 Cypress Ct, Jacksonville, NC 28540-4029 | 2007-03-06 |
| 1497882195 | Genesis Therapeutic Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 99 Village Dr Ste 12, Jacksonville, NC 28546-7060 | 2007-02-28 |
| 1831224849 | Irving Family Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 112 Lance Ct, Jacksonville, NC 28546-8640 | 2007-02-22 |
| 1639204233 | Moore Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 232 Newport Dr, Jacksonville, NC 28540-4005 | 2007-02-22 |
| 1720141542 | National Mentor Healthcare,llc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3615 Hodges Blvd, Jacksonville, FL 32224-1288 | 2006-12-19 |
| 1760971923 | Latrena M Thomas | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 14091 Summer Breeze Dr E, Jacksonville, FL 32218-8913 | 2018-05-03 |
| 1265693584 | Linda Elizabeth Gibson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 180 Coastal Ln, Jacksonville, NC 28546-6761 | 2008-06-19 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32217 |
Please comment or provide details below to improve the information on SERENITY RESIDENTIAL SERVICES INC.
| 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.