Provider Demographics
NPI:1104934892
Name:SERENITY LANE
Entity type:Organization
Organization Name:SERENITY LANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-284-8617
Mailing Address - Street 1:P.O. BOX 8549
Mailing Address - Street 2:1 SERENITY LANE
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408
Mailing Address - Country:US
Mailing Address - Phone:541-284-8605
Mailing Address - Fax:541-687-9041
Practice Address - Street 1:1 SERENITY LANE
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408
Practice Address - Country:US
Practice Address - Phone:541-284-8605
Practice Address - Fax:541-687-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty