Provider Demographics
NPI:1497289979
Name:SERENITY BEHAVIORAL HEALTH SERVICE LLC
Entity Type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-635-1414
Mailing Address - Street 1:4350 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-5610
Mailing Address - Country:US
Mailing Address - Phone:318-635-1414
Mailing Address - Fax:318-636-6107
Practice Address - Street 1:2000 CRESWELL AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2202
Practice Address - Country:US
Practice Address - Phone:318-635-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health