Provider Demographics
NPI:1801554787
Name:SERENITY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC LCADC
Authorized Official - Phone:410-585-7227
Mailing Address - Street 1:4920 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5601
Mailing Address - Country:US
Mailing Address - Phone:410-585-7227
Mailing Address - Fax:
Practice Address - Street 1:4920 BELAIR RD STE 1B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5601
Practice Address - Country:US
Practice Address - Phone:443-310-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2527Medicaid