Provider Demographics
NPI:1881225688
Name:JOURNEY 2 SERENITY, LLC
Entity Type:Organization
Organization Name:JOURNEY 2 SERENITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES-PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:917-309-9184
Mailing Address - Street 1:99 MAIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3109
Mailing Address - Country:US
Mailing Address - Phone:917-309-9184
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3109
Practice Address - Country:US
Practice Address - Phone:917-309-9184
Practice Address - Fax:845-267-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty