Provider Demographics
NPI:1053651505
Name:SERENITY VALLEY FAMILY NETWORK
Entity Type:Organization
Organization Name:SERENITY VALLEY FAMILY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-828-0024
Mailing Address - Street 1:215 PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3141
Mailing Address - Country:US
Mailing Address - Phone:313-828-0024
Mailing Address - Fax:
Practice Address - Street 1:215 PHILIP ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-3141
Practice Address - Country:US
Practice Address - Phone:313-828-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency