Provider Demographics
NPI:1528200631
Name:SERENITY PSYCHOSOCIAL SERVICES
Entity Type:Organization
Organization Name:SERENITY PSYCHOSOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:702-308-2288
Mailing Address - Street 1:2029 WINTER WIND ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6699
Mailing Address - Country:US
Mailing Address - Phone:702-343-4420
Mailing Address - Fax:702-543-2000
Practice Address - Street 1:2029 WINTER WIND ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6699
Practice Address - Country:US
Practice Address - Phone:702-343-4420
Practice Address - Fax:702-543-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0572251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health