Serenity Personal Care Residence

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

044-01716-9 Issued in GA

Legal business name

SERENITY PERSONAL CARE RESIDENCE

Practice address

2327 Young Rd
Stone Mountain, GA 30088-4111

Phone

(678) 908-0921

NPI assigned

May 4, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Almon Thompson

Title

Owner Administrator

Phone

(678) 908-0921

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1209859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209859200000",
    "number": "1083880629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5506 STONELEIGH CT",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300883433",
            "telephone_number": "678-908-0921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2327 YOUNG RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300884111",
            "telephone_number": "678-908-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY PERSONAL CARE RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-04",
        "last_updated": "2008-05-04",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "ALMON",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "678-908-0921",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "GA",
            "license": "044-01716-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.