Provider Demographics
NPI:1164707162
Name:SERENITY PSYCHIATRIC AND WELLNESS, INC.
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRIC AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-622-0249
Mailing Address - Street 1:184 W MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1243
Mailing Address - Country:US
Mailing Address - Phone:508-622-0249
Mailing Address - Fax:
Practice Address - Street 1:184 W MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1243
Practice Address - Country:US
Practice Address - Phone:508-622-0249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN233768251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health