Provider Demographics
NPI:1487993374
Name:SERENITY ESTATES LLC
Entity type:Organization
Organization Name:SERENITY ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:325-642-8645
Mailing Address - Street 1:401 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-4814
Mailing Address - Country:US
Mailing Address - Phone:940-325-3744
Mailing Address - Fax:940-325-6200
Practice Address - Street 1:401 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4814
Practice Address - Country:US
Practice Address - Phone:940-325-3744
Practice Address - Fax:940-325-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility