Provider Demographics
NPI:1265959209
Name:SERENITY ONE BEHAVIORAL HEALTH CARE, LLC.
Entity type:Organization
Organization Name:SERENITY ONE BEHAVIORAL HEALTH CARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-629-5815
Mailing Address - Street 1:2801 S VALLEY VIEW BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0176
Mailing Address - Country:US
Mailing Address - Phone:702-629-5815
Mailing Address - Fax:725-629-5815
Practice Address - Street 1:2801 S VALLEY VIEW BLVD STE 11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0176
Practice Address - Country:US
Practice Address - Phone:702-629-5815
Practice Address - Fax:725-629-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid