Provider Demographics
NPI:1427456680
Name:SERENITY RECOVERY CENTER
Entity type:Organization
Organization Name:SERENITY RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-987-6810
Mailing Address - Street 1:18 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2161
Mailing Address - Country:US
Mailing Address - Phone:859-987-6810
Mailing Address - Fax:859-987-6812
Practice Address - Street 1:18 CLINIC DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2161
Practice Address - Country:US
Practice Address - Phone:859-987-6810
Practice Address - Fax:859-987-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty