Provider Demographics
NPI:1598456659
Name:SERENITY CLINIC LLC
Entity Type:Organization
Organization Name:SERENITY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-256-7736
Mailing Address - Street 1:3175 S CONGRESS AVE STE 200E
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2515
Mailing Address - Country:US
Mailing Address - Phone:786-256-7736
Mailing Address - Fax:561-207-7808
Practice Address - Street 1:3175 S CONGRESS AVE STE 200E
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2515
Practice Address - Country:US
Practice Address - Phone:786-256-7736
Practice Address - Fax:561-207-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty