Provider Demographics
NPI:1457736340
Name:SERENITY LIGHT RECOVERY LLC
Entity Type:Organization
Organization Name:SERENITY LIGHT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OGBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-654-7280
Mailing Address - Street 1:3314 ONION CRK
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2546
Mailing Address - Country:US
Mailing Address - Phone:844-973-7364
Mailing Address - Fax:
Practice Address - Street 1:1820 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-8727
Practice Address - Country:US
Practice Address - Phone:844-973-7364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility