1508342536 NPI number — SERENITY BEHAVIORAL HEALTH SERVICES, LLC

Table of content: (NPI 1508342536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508342536 NPI number — SERENITY BEHAVIORAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY BEHAVIORAL HEALTH SERVICES, LLC
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:
SERENITY HEALTH NETWORK
Provider Other Organization Name Type Code:
3
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:
1508342536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 901246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33090-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-601-9007
Provider Business Mailing Address Fax Number:
786-272-0463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6475 SW 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33144-4843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-492-9978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WHIPPLE
Authorized Official First Name:
TOCOVIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
786-601-9007

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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