Provider Demographics
NPI:1487191235
Name:SH DETOX HOUSTON, LLC
Entity Type:Organization
Organization Name:SH DETOX HOUSTON, LLC
Other - Org Name:SERENITY HOUSE DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LCC
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-807-8471
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-2070
Mailing Address - Country:US
Mailing Address - Phone:954-336-7747
Mailing Address - Fax:954-212-2328
Practice Address - Street 1:9714 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1004
Practice Address - Country:US
Practice Address - Phone:832-240-3024
Practice Address - Fax:954-212-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility