Provider Demographics
NPI:1376416305
Name:SERENITY LANE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SERENITY LANE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ONOME
Authorized Official - Middle Name:T
Authorized Official - Last Name:OKURUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-244-1074
Mailing Address - Street 1:205 E DIMOND BLVD
Mailing Address - Street 2:PMB 582
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E BENSON BLVD STE 442
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4019
Practice Address - Country:US
Practice Address - Phone:907-244-1074
Practice Address - Fax:930-234-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty