Provider Demographics
NPI:1730051533
Name:SERENITY AND GRACE HEALTHCARE LLC
Entity type:Organization
Organization Name:SERENITY AND GRACE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-456-4647
Mailing Address - Street 1:3100 E 45TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1091
Mailing Address - Country:US
Mailing Address - Phone:347-456-4647
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 310
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1091
Practice Address - Country:US
Practice Address - Phone:347-456-4647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY AND GRACE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)