Provider Demographics
NPI:1972768323
Name:SERENITY CENTER
Entity Type:Organization
Organization Name:SERENITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKIMBALYNN
Authorized Official - Middle Name:MONEEK
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-851-2256
Mailing Address - Street 1:4313 KAITLYN CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1958
Mailing Address - Country:US
Mailing Address - Phone:757-851-2256
Mailing Address - Fax:757-405-3618
Practice Address - Street 1:106 FOX HILL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2309
Practice Address - Country:US
Practice Address - Phone:757-851-2256
Practice Address - Fax:757-851-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACO-404-08322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972768323Medicaid