Provider Demographics
NPI:1083903298
Name:SERENITY PSYCHIATRIC OUTPATIENT, LLC
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRIC OUTPATIENT, LLC
Other - Org Name:COLONIAL HAVEN REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-276-3909
Mailing Address - Street 1:4109 HIGHWAY 98 W
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-9132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 ARMORY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2110
Practice Address - Country:US
Practice Address - Phone:334-624-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty