Serenity Manor @Gwynn Oak Corp

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

30AL3565A Issued in MD

Legal business name

SERENITY MANOR @GWYNN OAK CORP

Practice address

5216 Gwynn Oak Ave
Baltimore, MD 21207-6807

Phone

(443) 801-3134

NPI assigned

Jul 6, 2016

Organization subpart

No

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

Authorized official

Name

Camille Matthews

Title

President

Phone

(443) 801-3134

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1407208168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5216 GWYNN OAK AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212076807",
            "telephone_number": "443-801-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5216 GWYNN OAK AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212076807",
            "telephone_number": "443-801-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY MANOR @GWYNN OAK CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-801-3134"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "30AL3565A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467589242",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5795420101",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serenity Behavioral Health LLC
• Serenity Experience Healing Center
• Serenity Group Home LLC
• Serenity Keepers of Maryland LLC
• Serenity Keepers of Maryland LLC
• Serenity Rehabiliation and Transitional Services LLC
• Serenity Space by LXC
• Serenity Wellness Mental Health Center LLC
• Diane Serex-Dougan, O.D.
• Jacwynne Danee Sergeant

• Assisted Living Facility in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Assisted Living Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.