Provider Demographics
NPI:1184669145
Name:SERENITY OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:SERENITY OUTPATIENT SERVICES, INC.
Other - Org Name:SOS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRUZICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:915-566-2000
Mailing Address - Street 1:4625 ALABAMA ST, STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930
Mailing Address - Country:US
Mailing Address - Phone:915-566-2000
Mailing Address - Fax:915-566-2056
Practice Address - Street 1:4625 ALABAMA ST,
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930
Practice Address - Country:US
Practice Address - Phone:915-566-2000
Practice Address - Fax:915-566-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564-A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)