Provider Demographics
NPI:1568630879
Name:SERENITY HEALTH CENTER PA
Entity Type:Organization
Organization Name:SERENITY HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRITHA
Authorized Official - Middle Name:RAJESHWORI
Authorized Official - Last Name:DHUNGANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-241-9282
Mailing Address - Street 1:835 OAKLEY SEAVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1968
Mailing Address - Country:US
Mailing Address - Phone:352-241-9282
Mailing Address - Fax:352-241-4282
Practice Address - Street 1:835 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:352-241-9282
Practice Address - Fax:352-241-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93964OtherMEDICAL LICENSE