Provider Demographics
NPI:1407690530
Name:SERENITY MENTAL HEALTH SPECIALISTS LLC
Entity type:Organization
Organization Name:SERENITY MENTAL HEALTH SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANGELOV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:727-488-1452
Mailing Address - Street 1:3502 W TACON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7929
Mailing Address - Country:US
Mailing Address - Phone:727-488-1452
Mailing Address - Fax:
Practice Address - Street 1:3502 W TACON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7929
Practice Address - Country:US
Practice Address - Phone:727-488-1452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility