# SERENITY RANCH ASSISTED LIVING HOME, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659637486
- **Authorized official:** MS. LU ANN SAMUELSON ADMINASTRATIVE (OWNER)
- **Authorized official phone:** (954) 533-9184

## Contact information

- **Practice address:** 12475 SW 58TH ST, SOUTHWEST RANCHES, FL 33330-3201
- **Practice address phone:** (954) 533-9184
- **Practice address fax:** (954) 763-2162
- **Mailing address:** 12475 SW 58TH ST, SOUTHWEST RANCHES, FL 33330-3201
- **Mailing address phone:** (954) 533-9184
- **Mailing address fax:** (954) 763-2162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | AL11718 | FL | Yes |

## Other

- **Enumeration date:** 04/05/2012
- **Last updated:** 04/05/2012