1144273848 NPI number — SERENITY CENTER FOR THERAPEUTIC SERVICES INC

Table of content: DR. CLARKE GARRETT STOLTZFUS MD (NPI 1629828108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144273848 NPI number — SERENITY CENTER FOR THERAPEUTIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY CENTER FOR THERAPEUTIC SERVICES INC
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:
1144273848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 NW 27TH ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33122-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-716-8637
Provider Business Mailing Address Fax Number:
305-716-8693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 NW 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33122-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-716-8603
Provider Business Practice Location Address Fax Number:
305-716-8693
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MENENDEZ
Authorized Official First Name:
MERCEDES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-716-8637

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  HCC4221 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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