Provider Demographics
NPI:1659092096
Name:ARC SERENITY SERVICE
Entity Type:Organization
Organization Name:ARC SERENITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:832-677-7015
Mailing Address - Street 1:13521 MONTFORT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5120
Mailing Address - Country:US
Mailing Address - Phone:214-302-7171
Mailing Address - Fax:657-213-2652
Practice Address - Street 1:13521 MONTFORT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5120
Practice Address - Country:US
Practice Address - Phone:214-302-7171
Practice Address - Fax:657-213-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1075618OtherLICENSE