Provider Demographics
NPI:1891184735
Name:SERENITY OUTPATIENT SERVICES
Entity type:Organization
Organization Name:SERENITY OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-539-3713
Mailing Address - Street 1:330 BURCHWOOD BAY RD
Mailing Address - Street 2:#G72
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7184
Mailing Address - Country:US
Mailing Address - Phone:501-539-3713
Mailing Address - Fax:501-421-9494
Practice Address - Street 1:4332 CENTRAL AVE
Practice Address - Street 2:SUITE O
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7437
Practice Address - Country:US
Practice Address - Phone:501-539-4940
Practice Address - Fax:501-421-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3590-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR037040Medicare Oscar/Certification