Provider Demographics
NPI:1164061776
Name:SERENITY TREATMENT CENTER OF LOUISIANA LLC
Entity Type:Organization
Organization Name:SERENITY TREATMENT CENTER OF LOUISIANA LLC
Other - Org Name:SERENITY TREATMENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-855-9023
Mailing Address - Street 1:2325 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1481
Mailing Address - Country:US
Mailing Address - Phone:225-361-0899
Mailing Address - Fax:225-367-1422
Practice Address - Street 1:2325 WEYMOUTH DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1481
Practice Address - Country:US
Practice Address - Phone:225-361-0899
Practice Address - Fax:225-367-1422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY TREATMENT CENTER OF LOUISIANA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty