NPIMap

Organization Active NPI

Serenity Square L.L.C

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Ft. Worth, TX
National Provider Identifier
1013439686
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
SERENITY SQUARE L.L.C
Practice address
1121 Kielder Cir
Ft. Worth, TX 76134
Phone
(817) 877-7466
NPI assigned
Jul 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Awndrea WalkerNPI 1114463650
Title
Ceo
Phone
(817) 877-7466

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X

Addresses

Primary practice location

1121 Kielder Cir
Ft. Worth, TX 76134

Mailing address

1121 Kielder Cir
Ft Worth, TX 76134-4514

Other practice location 1

1121 Kielder Cir
Ft. Worth, TX 76134
Phone (817) 877-7466

Other identifiers 1

IdentifierTypeStateIssuer
14601517MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1013439686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 KIELDER CIR",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761344514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 KIELDER CIR",
            "city": "FT. WORTH",
            "state": "TX",
            "postal_code": "76134",
            "telephone_number": "817-877-7466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 Kielder Cir",
            "address_purpose": "LOCATION",
            "city": "Ft. Worth",
            "state": "TX",
            "postal_code": "76134",
            "country_code": "US",
            "telephone_number": "817-877-7466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SERENITY SQUARE L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-14",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "AWNDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-877-7466"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14601517",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft. Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.