Provider Demographics
NPI:1497397723
Name:SERENITY WELLNESS, LLC
Entity Type:Organization
Organization Name:SERENITY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:ST.GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, ICADC
Authorized Official - Phone:208-800-0588
Mailing Address - Street 1:524 CLEVELAND BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4076
Mailing Address - Country:US
Mailing Address - Phone:208-800-0588
Mailing Address - Fax:208-800-0599
Practice Address - Street 1:524 CLEVELAND BLVD STE 230
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4076
Practice Address - Country:US
Practice Address - Phone:208-800-0588
Practice Address - Fax:208-800-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility