Provider Demographics
NPI:1386110955
Name:SERENITY RECOVERY SERVICES
Entity type:Organization
Organization Name:SERENITY RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:267-291-4513
Mailing Address - Street 1:93 OLD YORK RD # 1-526
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3925
Mailing Address - Country:US
Mailing Address - Phone:267-361-8308
Mailing Address - Fax:215-701-5888
Practice Address - Street 1:8410 BUSTLETON AVE STE 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1924
Practice Address - Country:US
Practice Address - Phone:267-361-8308
Practice Address - Fax:215-701-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty