Provider Demographics
NPI:1558902916
Name:SERENITY SOBER LIVVING, LLC
Entity Type:Organization
Organization Name:SERENITY SOBER LIVVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUNDEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-534-9205
Mailing Address - Street 1:145 MACON DR
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3317
Mailing Address - Country:US
Mailing Address - Phone:337-534-9205
Mailing Address - Fax:
Practice Address - Street 1:4600 REDDIX LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-5949
Practice Address - Country:US
Practice Address - Phone:337-534-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility