Provider Demographics
NPI:1699549600
Name:SERENITYS PLACE, INC
Entity type:Organization
Organization Name:SERENITYS PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REIGN
Authorized Official - Middle Name:LOTHEL
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-490-5511
Mailing Address - Street 1:468 EDDLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6117
Mailing Address - Country:US
Mailing Address - Phone:704-490-5511
Mailing Address - Fax:
Practice Address - Street 1:106 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:NC
Practice Address - Zip Code:28073-9715
Practice Address - Country:US
Practice Address - Phone:704-856-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility