| Organization Name: | SERENITY RANCH ASSISTED LIVING HOME, INC |
| NPI Number: | 1659637486 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LU ANN SAMUELSON (OWNER) |
| Mailing Address: | 12475 Sw 58th St Southwest Ranches |
| State: | FL US |
| Postal Code: | 333303201 |
| Phone Number: | 9545339184 |
| Fax Number: | 9547632162 |
| NPI Enumeration Date: | 04/05/2012 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | AL11718 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |