Organization
SERENITY SUPPORTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAMILLAE' TAWNYANETTA WORTHINGTON (CEO/OWNER)
(252) 823-0555
Entity
Organization
Contact information
Practice address
201 E PITT ST, SUITE 208-209, TARBORO, NC 27886-5192
(252) 823-0555
Mailing address
216 JOHN AVE, GREENVILLE, NC 27858-4112
(252) 754-9963
(252) 754-9964
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/05/2012
Last updated
03/05/2012
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