Provider Demographics
NPI:1285170670
Name:SERENITY INFUSION CENTER OF SOUTH JERSEY, LLC
Entity type:Organization
Organization Name:SERENITY INFUSION CENTER OF SOUTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-344-7982
Mailing Address - Street 1:614 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1246
Mailing Address - Country:US
Mailing Address - Phone:856-344-7982
Mailing Address - Fax:856-344-7984
Practice Address - Street 1:110 AMERICAN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1767
Practice Address - Country:US
Practice Address - Phone:856-344-7982
Practice Address - Fax:856-344-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy