Organization
SERENITY SQUARE L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AWNDREA WALKER (CEO)
(817) 877-7466
Entity
Organization
Contact information
Practice address
1121 KIELDER CIR, FT. WORTH, TX 76134
(817) 877-7466
Mailing address
1121 KIELDER CIR, FT WORTH, TX 76134-4514
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14601517
—
TX
Enumeration date
07/14/2017
Last updated
06/16/2018
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