Provider Demographics
NPI:1023833514
Name:SERENE SUPPORT
Entity type:Organization
Organization Name:SERENE SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-244-4686
Mailing Address - Street 1:14718 COBBS POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5918
Mailing Address - Country:US
Mailing Address - Phone:804-244-4686
Mailing Address - Fax:
Practice Address - Street 1:14718 COBBS POINT DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-5918
Practice Address - Country:US
Practice Address - Phone:804-244-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health