Provider Demographics
NPI:1760842454
Name:SERENITY COMMUNITY WELLNESS CENTERS
Entity Type:Organization
Organization Name:SERENITY COMMUNITY WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-204-0150
Mailing Address - Street 1:4112 HELENS POUROFF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4460
Mailing Address - Country:US
Mailing Address - Phone:702-204-0150
Mailing Address - Fax:702-586-8207
Practice Address - Street 1:4040 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-331-9619
Practice Address - Fax:702-331-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care