Provider Demographics
NPI:1831845510
Name:SERENITY COTTAGES OF THE DESERT
Entity type:Organization
Organization Name:SERENITY COTTAGES OF THE DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:909-389-8582
Mailing Address - Street 1:1897 E COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9797
Mailing Address - Country:US
Mailing Address - Phone:909-389-8582
Mailing Address - Fax:
Practice Address - Street 1:57131 LAKEVIEW RD.
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:CA
Practice Address - Zip Code:92309-9230
Practice Address - Country:US
Practice Address - Phone:909-389-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY COTTAGES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder