Provider Demographics
NPI:1134690258
Name:SERENITY PRIMARY CARE & RECOVERY LLC
Entity type:Organization
Organization Name:SERENITY PRIMARY CARE & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:812-913-3818
Mailing Address - Street 1:1002 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8785
Mailing Address - Country:US
Mailing Address - Phone:502-544-0192
Mailing Address - Fax:
Practice Address - Street 1:2708 PAOLI PIKE STE I
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-5100
Practice Address - Country:US
Practice Address - Phone:812-725-7894
Practice Address - Fax:812-590-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty