Provider Demographics
NPI:1972149078
Name:SERENITYBEHAVIORALHEALTH.LLC
Entity type:Organization
Organization Name:SERENITYBEHAVIORALHEALTH.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-302-6217
Mailing Address - Street 1:15202 N FLAMENCO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4872
Mailing Address - Country:US
Mailing Address - Phone:520-302-6217
Mailing Address - Fax:602-907-4562
Practice Address - Street 1:15202 N FLAMENCO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4872
Practice Address - Country:US
Practice Address - Phone:520-302-6217
Practice Address - Fax:602-907-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility