St Croix Serenity Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

ST CROIX SERENITY HOME LLC

Practice address

519 8TH St N # B
Hudson, WI 54016-1140

Phone

(517) 505-0174

NPI assigned

Jun 17, 2024

Organization subpart

No

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

Authorized official

Name

Mohamed A Mohamed

Title

Ceo

Phone

(517) 505-0174

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1295578151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 8TH ST N # B",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540161140",
            "telephone_number": "517-505-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 8TH ST N # B",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540161140",
            "telephone_number": "517-505-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX SERENITY HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "517-505-0174"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Soukup
• Judith Lorraine Souther, OTR
• Dawn Marie Spanton, COTA
• Krista St Aubin, LMFT
• St Croix Periodontics
• St Croix Therapy Inc
• St. Croix Orthopaedics, P.a.
• St. Croix Valley Dental, PLLC
• St. Croix Women'S Center, S.C.
• Samantha Caitlin Stancliffe, CPM

• Adult Care Home Facility in Hudson, WI
• Providers in Hudson, WI by specialty
• Adult Care Home Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.