Provider Demographics
NPI:1093408171
Name:JV SERENITY MASS LLC
Entity Type:Organization
Organization Name:JV SERENITY MASS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, LPC
Authorized Official - Phone:855-219-1877
Mailing Address - Street 1:PO BOX 31296
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3296
Mailing Address - Country:US
Mailing Address - Phone:855-219-1877
Mailing Address - Fax:954-337-6238
Practice Address - Street 1:61 BROWN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6750
Practice Address - Country:US
Practice Address - Phone:855-219-1877
Practice Address - Fax:954-337-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility