Provider Demographics
NPI:1912374497
Name:SERENITY HOUSE DETOX PALM BEACH, LLC
Entity Type:Organization
Organization Name:SERENITY HOUSE DETOX PALM BEACH, LLC
Other - Org Name:SERENITY HOUSE DETOX JUPITER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-244-5481
Mailing Address - Street 1:2973 HARBOR BLVD # 140
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:949-414-4657
Mailing Address - Fax:
Practice Address - Street 1:250 THELMA AVE
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8091
Practice Address - Country:US
Practice Address - Phone:561-475-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility