Provider Demographics
NPI:1114474939
Name:SERENITY HEALTHCARE BEHAVIORAL & OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:SERENITY HEALTHCARE BEHAVIORAL & OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA'SHON
Authorized Official - Middle Name:DANETTE
Authorized Official - Last Name:RUBIN-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-326-0378
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-0087
Mailing Address - Country:US
Mailing Address - Phone:337-326-0378
Mailing Address - Fax:
Practice Address - Street 1:838 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6118
Practice Address - Country:US
Practice Address - Phone:337-326-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health