SERENITY VILLAGE INC NPI 1811649882

NPI Information

NPI: 1811649882
Provider Name: SERENITY VILLAGE INC
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
3420 S DALE MABRY HWY STE S
TAMPA, FL
ZIP 33629
Phone: (727) 648-4925
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SERENITY VILLAGE INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Tampa, FL. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SERENITY VILLAGE INC NPI is 1811649882. The provider is registered as an organization entity type.

The provider's business location address is:

3420 S DALE MABRY HWY STE S
TAMPA, FL
ZIP 33629-660
Phone: (727) 648-4925

The provider's authorized official is Gary T Hartfield .
The authorized official title is President and has the following contact phone number (727) 452-8744.

The enumeration date for this NPI number is 1/21/2022 and was last updated on 1/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	251C00000X	Day Training, Developmentally Disabled Services	No
2	310400000X	Assisted Living Facility	No
3	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities	No
4	373H00000X	Day Training/Habilitation Specialist	No
5	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	685663296	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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