Provider Demographics
NPI:1952611428
Name:SERENITY HAVEN
Entity type:Organization
Organization Name:SERENITY HAVEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-859-3226
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:117 ALLEN ST.
Mailing Address - City:ARP
Mailing Address - State:TX
Mailing Address - Zip Code:75750-0474
Mailing Address - Country:US
Mailing Address - Phone:903-859-3226
Mailing Address - Fax:903-859-2667
Practice Address - Street 1:117 ALLEN ST.
Practice Address - Street 2:
Practice Address - City:ARP
Practice Address - State:TX
Practice Address - Zip Code:75750
Practice Address - Country:US
Practice Address - Phone:903-859-3226
Practice Address - Fax:903-859-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103986320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103986Medicaid