Provider Demographics
NPI:1730622168
Name:SERENITY ADVANTAGE CARE, LLC
Entity type:Organization
Organization Name:SERENITY ADVANTAGE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-364-0248
Mailing Address - Street 1:10669 HIGHWAY 53 W
Mailing Address - Street 2:
Mailing Address - City:TALKING ROCK
Mailing Address - State:GA
Mailing Address - Zip Code:30175-3465
Mailing Address - Country:US
Mailing Address - Phone:770-364-0248
Mailing Address - Fax:
Practice Address - Street 1:10669 HIGHWAY 53 W
Practice Address - Street 2:
Practice Address - City:TALKING ROCK
Practice Address - State:GA
Practice Address - Zip Code:30175-3465
Practice Address - Country:US
Practice Address - Phone:770-364-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16109324251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services