Provider Demographics
NPI:1497247977
Name:SISTER-TO-SISTER 2, INC.
Entity Type:Organization
Organization Name:SISTER-TO-SISTER 2, INC.
Other - Org Name:SERENITY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JETAUN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:510-891-0464
Mailing Address - Street 1:2363A SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1136
Mailing Address - Country:US
Mailing Address - Phone:510-891-0464
Mailing Address - Fax:
Practice Address - Street 1:2363A SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1136
Practice Address - Country:US
Practice Address - Phone:510-891-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness