Provider Demographics
NPI:1972130821
Name:THE SERENITY HOUSE OF FLINT
Entity Type:Organization
Organization Name:THE SERENITY HOUSE OF FLINT
Other - Org Name:SERENITY HOUSE COMMUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MORENO-WALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ADS
Authorized Official - Phone:810-893-1276
Mailing Address - Street 1:1019 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1044
Mailing Address - Country:US
Mailing Address - Phone:810-893-1276
Mailing Address - Fax:
Practice Address - Street 1:1019 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1044
Practice Address - Country:US
Practice Address - Phone:810-893-1276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health