1285494989 NPI number — SERENITY4U, PLLC

Table of content: (NPI 1417546904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285494989 NPI number — SERENITY4U, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY4U, PLLC
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:
1285494989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6620 OLD GREENSBORO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27516-8529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-619-4193
Provider Business Mailing Address Fax Number:
919-619-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6620 OLD GREENSBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27516-8529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-619-4193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMMOCK
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
BRANDT
Authorized Official Title or Position:
ORGANIZER, MANAGER
Authorized Official Telephone Number:
919-619-4193

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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