Provider Demographics
NPI:1649984741
Name:SERENITY INTEGRATED PRACTICE SIP LLC
Entity type:Organization
Organization Name:SERENITY INTEGRATED PRACTICE SIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARSICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHERU
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:146-531-6583
Mailing Address - Street 1:5719 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7339
Mailing Address - Country:US
Mailing Address - Phone:614-961-7639
Mailing Address - Fax:
Practice Address - Street 1:700 BRYDEN RD # 122
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4839
Practice Address - Country:US
Practice Address - Phone:146-787-5183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty