Provider Demographics
NPI:1932423472
Name:SERENITY HOUSE CALL
Entity Type:Organization
Organization Name:SERENITY HOUSE CALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-639-3322
Mailing Address - Street 1:6975 SW SANDBURG ST
Mailing Address - Street 2:SUITE #190
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8073
Mailing Address - Country:US
Mailing Address - Phone:503-639-3322
Mailing Address - Fax:888-883-6139
Practice Address - Street 1:6975 SW SANDBURG ST
Practice Address - Street 2:SUITE #190
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8073
Practice Address - Country:US
Practice Address - Phone:503-639-3322
Practice Address - Fax:888-883-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty