Provider Demographics
NPI:1245967751
Name:SERENITY MENTAL HEALTH AND REHABILITATIVE SERVICES INC
Entity type:Organization
Organization Name:SERENITY MENTAL HEALTH AND REHABILITATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:IRINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ACHUAMANG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:781-205-9944
Mailing Address - Street 1:609 DEEP VALLEY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3614
Mailing Address - Country:US
Mailing Address - Phone:781-205-9944
Mailing Address - Fax:
Practice Address - Street 1:609 DEEP VALLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3614
Practice Address - Country:US
Practice Address - Phone:781-205-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty