Provider Demographics
NPI:1205550910
Name:SERENITY ABA THERAPY LLC
Entity type:Organization
Organization Name:SERENITY ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-461-4403
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY STE 9B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5991
Mailing Address - Country:US
Mailing Address - Phone:725-333-4005
Mailing Address - Fax:702-825-3556
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 9B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5991
Practice Address - Country:US
Practice Address - Phone:725-333-4005
Practice Address - Fax:702-825-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty