Provider Demographics
NPI:1609026228
Name:SERENITY MANOR CORPORATION
Entity type:Organization
Organization Name:SERENITY MANOR CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TEIZO
Authorized Official - Middle Name:DEVOTNAE
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:214-929-6761
Mailing Address - Street 1:4722 MEADOW ST
Mailing Address - Street 2:APT 403
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-4707
Mailing Address - Country:US
Mailing Address - Phone:214-929-6761
Mailing Address - Fax:
Practice Address - Street 1:4722 MEADOW ST
Practice Address - Street 2:APT 403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4707
Practice Address - Country:US
Practice Address - Phone:214-929-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility