# SERENITY INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SERENITY INCORPORATED
- **Other names:** Serenity Place IV
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1699802827
- **Legal business name:** SERENITY INCORPORATED
- **Authorized official:** MRS. CLARICE SHYLLON FAULKNER RN (PRESIDENT)
- **Authorized official phone:** (919) 771-9173

## Contact information

- **Practice address:** 5040 KAPLAN DR, RALEIGH, NC 27606-2523
- **Practice address phone:** (919) 771-9173
- **Practice address fax:** (919) 367-0816
- **Mailing address:** PO BOX 1583, CARY, NC 27512-1583
- **Mailing address phone:** (919) 771-9173
- **Mailing address fax:** (919) 367-0816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | MHL-092-464 | NC | Yes |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 06/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7804212 | — | NC |