Provider Demographics
NPI:1912465295
Name:SERENITY PARK TREATMENT CENTER
Entity type:Organization
Organization Name:SERENITY PARK TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIERNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-313-0066
Mailing Address - Street 1:2801 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-5655
Mailing Address - Country:US
Mailing Address - Phone:501-313-0066
Mailing Address - Fax:501-313-2044
Practice Address - Street 1:2801 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-5655
Practice Address - Country:US
Practice Address - Phone:501-313-0066
Practice Address - Fax:501-313-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility