Provider Demographics
NPI:1679041552
Name:SERENITY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:SERENITY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-617-7337
Mailing Address - Street 1:PO BOX 4094
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-4094
Mailing Address - Country:US
Mailing Address - Phone:336-617-7337
Mailing Address - Fax:
Practice Address - Street 1:2216 W MEADOWVIEW RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3401
Practice Address - Country:US
Practice Address - Phone:336-617-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health