Provider Demographics
NPI:1962016626
Name:SERENITY PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:SERENITY PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-452-0202
Mailing Address - Street 1:107 CALLE DEL NORTE # 17107
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-9104
Mailing Address - Country:US
Mailing Address - Phone:956-723-1234
Mailing Address - Fax:956-725-5536
Practice Address - Street 1:107 CALLE DEL NORTE # 17
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-9104
Practice Address - Country:US
Practice Address - Phone:956-452-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty