Provider Demographics
NPI:1093085854
Name:SERENITY FOR LIFE CENTER
Entity Type:Organization
Organization Name:SERENITY FOR LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:LIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS/MMHC, BS, SAC-IT
Authorized Official - Phone:414-426-5266
Mailing Address - Street 1:8624 W GREEN BROOK DR
Mailing Address - Street 2:LOWER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2127
Mailing Address - Country:US
Mailing Address - Phone:414-426-5266
Mailing Address - Fax:
Practice Address - Street 1:8624 W GREEN BROOK DR
Practice Address - Street 2:LOWER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2127
Practice Address - Country:US
Practice Address - Phone:414-426-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management