Provider Demographics
NPI:1861936163
Name:SERENITY LIVING OF BLAKELY
Entity type:Organization
Organization Name:SERENITY LIVING OF BLAKELY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:ZACHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-724-8152
Mailing Address - Street 1:83 BOB WHITE AVE
Mailing Address - Street 2:POST OFFICE BOX 144
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2630
Mailing Address - Country:US
Mailing Address - Phone:229-724-8152
Mailing Address - Fax:
Practice Address - Street 1:83 BOB WHITE AVE
Practice Address - Street 2:POST OFFICE BOX 144
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2630
Practice Address - Country:US
Practice Address - Phone:229-724-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049-R-1476251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health