1780008243 NPI number — SERENITY PALMS AN IRECOVER TREATMENT CENTERS INC.

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 1780008243 NPI number — SERENITY PALMS AN IRECOVER TREATMENT CENTERS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY PALMS AN IRECOVER TREATMENT CENTERS 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:
1780008243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37066 BANKSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATHEDRAL CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92234-7815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-761-6007
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37066 BANKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-7815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-761-6007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
866-761-6007

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  330113AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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