NPIMap

Organization Active NPI

Serenity Incorporated

  • Adult Care Home Facility
  • Raleigh, NC
National Provider Identifier
1013044247
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
MHL-092-443 Issued in NC
Legal business name
SERENITY INCORPORATED
Practice address
5005 Hollyridge Dr
Raleigh, NC 27612-3109
Phone
(919) 771-9173
Fax
(919) 367-0816
NPI assigned
Feb 27, 2007
Organization subpart
Yes
Parent organization
SERENITY INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Clarice Shyllon Faulkner, RN
Title
President
Phone
(919) 771-9173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X MHL-092-443 NC Primary

Addresses

Primary practice location

5005 Hollyridge Dr
Raleigh, NC 27612-3109

Mailing address

PO Box 1583
Cary, NC 27512-1583
Phone (919) 771-9173

Other identifiers 1

IdentifierTypeStateIssuer
7804101MedicaidNC

Other names 1

  • Serenity Place III Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Serenity Incorporated4 organizations share this tax ID, including this one
Part of
Serenity Incorporated

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1013044247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1583",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275121583",
            "telephone_number": "919-771-9173",
            "fax_number": "919-367-0816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 HOLLYRIDGE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123109",
            "telephone_number": "919-771-9173",
            "fax_number": "919-367-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SERENITY INCORPORATED",
        "enumeration_date": "2007-02-27",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "CLARICE",
        "authorized_official_middle_name": "SHYLLON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-771-9173",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-092-443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804101",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Place III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.