Provider Demographics
NPI:1568966414
Name:SERENITY ALTERNATIVE HEALTHCARE & ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:SERENITY ALTERNATIVE HEALTHCARE & ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:III
Authorized Official - Credentials:AP
Authorized Official - Phone:386-628-1088
Mailing Address - Street 1:595 SW INFINITY PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-5378
Mailing Address - Country:US
Mailing Address - Phone:386-628-1088
Mailing Address - Fax:
Practice Address - Street 1:1009 SW MAIN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5784
Practice Address - Country:US
Practice Address - Phone:386-628-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000033338261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center