Serenity Supported Living

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SERENITY SUPPORTED LIVING

Practice address

201 E Pitt St
Suite 208-209
Tarboro, NC 27886-5192

Phone

(252) 823-0555

NPI assigned

Mar 5, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Camillae' Tawnyanetta Worthington

Title

Ceo/Owner

Phone

(252) 823-0555

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1427322742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 JOHN AVE",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278584112",
            "telephone_number": "252-754-9963",
            "fax_number": "252-754-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E PITT ST",
            "address_2": "SUITE 208-209",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278865192",
            "telephone_number": "252-823-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SUPPORTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-05",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "WORTHINGTON",
        "authorized_official_first_name": "CAMILLAE'",
        "authorized_official_middle_name": "TAWNYANETTA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "252-823-0555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tarboro, NC
• Providers in Tarboro, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.