Provider Demographics
NPI:1780008243
Name:SERENITY PALMS AN IRECOVER TREATMENT CENTERS INC.
Entity Type:Organization
Organization Name:SERENITY PALMS AN IRECOVER TREATMENT CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-761-6007
Mailing Address - Street 1:37066 BANKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7815
Mailing Address - Country:US
Mailing Address - Phone:866-761-6007
Mailing Address - Fax:
Practice Address - Street 1:37066 BANKSIDE DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7815
Practice Address - Country:US
Practice Address - Phone:866-761-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330113AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility