Provider Demographics
NPI:1598344665
Name:SERENITY'S BABY SPA
Entity Type:Organization
Organization Name:SERENITY'S BABY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ARDENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEILH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:918-378-9751
Mailing Address - Street 1:4105 S REDBUD AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1637
Mailing Address - Country:US
Mailing Address - Phone:918-378-9751
Mailing Address - Fax:
Practice Address - Street 1:4105 S REDBUD AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1637
Practice Address - Country:US
Practice Address - Phone:918-378-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty