Provider Demographics
NPI:1336808823
Name:SERENITY BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOCOVIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-601-9007
Mailing Address - Street 1:100 NE 15TH ST STE 103B
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4564
Mailing Address - Country:US
Mailing Address - Phone:786-601-9007
Mailing Address - Fax:786-272-0463
Practice Address - Street 1:100 NE 15TH ST STE 103B
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4564
Practice Address - Country:US
Practice Address - Phone:786-601-9007
Practice Address - Fax:786-272-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty