Provider Demographics
NPI:1093257529
Name:SERENITY CENTER OF YOUNGSTOWN, LLC
Entity Type:Organization
Organization Name:SERENITY CENTER OF YOUNGSTOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & CONTRACTING COORD
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-965-9999
Mailing Address - Street 1:11369 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-9782
Mailing Address - Country:US
Mailing Address - Phone:330-965-9999
Mailing Address - Fax:330-757-0000
Practice Address - Street 1:11369 MARKET ST
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-9782
Practice Address - Country:US
Practice Address - Phone:330-965-9999
Practice Address - Fax:330-757-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14088251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193685Medicaid
OH1093257529OtherTYPE 95 NPI