Provider Demographics
NPI:1376876656
Name:SERENITY CONCEPTS CENTER
Entity Type:Organization
Organization Name:SERENITY CONCEPTS CENTER
Other - Org Name:DEBRA MCSHEFFERY DBA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCSHEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-801-1812
Mailing Address - Street 1:3838 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2234
Mailing Address - Country:US
Mailing Address - Phone:614-801-1812
Mailing Address - Fax:614-801-1814
Practice Address - Street 1:3838 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2234
Practice Address - Country:US
Practice Address - Phone:614-801-1812
Practice Address - Fax:614-801-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0360474Medicaid