Provider Demographics
NPI:1407407570
Name:SERENITY PARK RECOVERY CLINIC
Entity Type:Organization
Organization Name:SERENITY PARK RECOVERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-313-0066
Mailing Address - Street 1:2801 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-5655
Mailing Address - Country:US
Mailing Address - Phone:501-313-0066
Mailing Address - Fax:501-313-2059
Practice Address - Street 1:2711 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-5668
Practice Address - Country:US
Practice Address - Phone:501-313-0066
Practice Address - Fax:501-313-2059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY PARK TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder