Provider Demographics
NPI:1144064445
Name:SERENITY RESIDENTIAL APARTMENTS LLC
Entity type:Organization
Organization Name:SERENITY RESIDENTIAL APARTMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-839-0319
Mailing Address - Street 1:1109 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2131
Mailing Address - Country:US
Mailing Address - Phone:414-839-0319
Mailing Address - Fax:414-240-6438
Practice Address - Street 1:4438 N 44TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5242
Practice Address - Country:US
Practice Address - Phone:414-839-0319
Practice Address - Fax:414-240-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care