Provider Demographics
NPI:1043933344
Name:SERENITY RECOVERY CENTER
Entity Type:Organization
Organization Name:SERENITY RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:FARTUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDERE
Authorized Official - Suffix:
Authorized Official - Credentials:ADC-T
Authorized Official - Phone:612-298-2987
Mailing Address - Street 1:2080 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5112
Mailing Address - Country:US
Mailing Address - Phone:612-298-2987
Mailing Address - Fax:
Practice Address - Street 1:2080 11TH AVE E
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-5112
Practice Address - Country:US
Practice Address - Phone:612-298-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty