Provider Demographics
NPI:1790504561
Name:SERENITY TREATMENT
Entity type:Organization
Organization Name:SERENITY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-305-8237
Mailing Address - Street 1:1034 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1842
Mailing Address - Country:US
Mailing Address - Phone:208-743-5906
Mailing Address - Fax:833-264-6643
Practice Address - Street 1:1034 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1842
Practice Address - Country:US
Practice Address - Phone:208-743-5906
Practice Address - Fax:833-264-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health