Provider Demographics
NPI:1417547290
Name:SERENITEE AT ITS BEST
Entity Type:Organization
Organization Name:SERENITEE AT ITS BEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:859-753-7752
Mailing Address - Street 1:PO BOX 4428
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:KY
Mailing Address - Zip Code:40347-4428
Mailing Address - Country:US
Mailing Address - Phone:859-753-7752
Mailing Address - Fax:
Practice Address - Street 1:545 DAVISTOWN RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-9504
Practice Address - Country:US
Practice Address - Phone:859-753-7752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100537150Medicaid