Provider Demographics
NPI:1649059957
Name:SERENITY LIFE WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SERENITY LIFE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:OSWALDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC QS
Authorized Official - Phone:407-946-0093
Mailing Address - Street 1:4903 MARK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1753
Mailing Address - Country:US
Mailing Address - Phone:407-797-7298
Mailing Address - Fax:407-386-0032
Practice Address - Street 1:4903 MARK CT
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1753
Practice Address - Country:US
Practice Address - Phone:407-797-7298
Practice Address - Fax:407-386-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty