1891184735 NPI number — SERENITY OUTPATIENT SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891184735 NPI number — SERENITY OUTPATIENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY OUTPATIENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891184735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 BURCHWOOD BAY RD
Provider Second Line Business Mailing Address:
#G72
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-7184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-539-3713
Provider Business Mailing Address Fax Number:
501-421-9494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4332 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE O
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-7437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-539-4940
Provider Business Practice Location Address Fax Number:
501-421-9494
Provider Enumeration Date:
01/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
APRIL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-539-3713

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3590-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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