St Croix Serenity Home LLC
Custodial Care Facility, Adult Care Home in Hudson, WI. Organization (NPI-2).
NPI number1295578151
StatusActive
Last updated in NPPESJun 17, 2024
Details
- NPI
- 1295578151
- Entity type
- Organization (NPI-2)
- Legal business name
- St Croix Serenity Home LLC
- Organization subpart
- No
- Enumeration date
- Jun 17, 2024
- Certification date
- Jun 17, 2024
- Last updated
- Jun 17, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311ZA0620X | Custodial Care Facility, Adult Care Home | – | – | Yes |
Practice location
519 8th St N # BHudson, WI 54016-1140
Phone 517-505-0174
Mailing address
519 8th St N # BHudson, WI 54016-1140
Phone 517-505-0174
Authorized official
Mohamed A Mohamed
Ceo
5175050174
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