MEDICARE: SERENITY NOW HEALTHCARE OF MS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261Q00000X	Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM1300X	Multi-Specialty Clinic/Center
5	261QP2300X	Primary Care Clinic/Center
6	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1114432739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY NOW HEALTHCARE OF MS LLC

Provider Business Mailing Address
First Line	:	5011 VIRGINIA ST
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39520-7010
Country	:	US
Telephone Number	:	888-371-1924
Fax Number	:	888-371-1924

Provider Business Practice Location Address
First Line	:	5011 VIRGINIA ST
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39520-7010
Country	:	US
Telephone Number	:	888-371-1924
Fax Number	:	888-371-1924

Authorized Official
Title or Position	:	OWNER
Name	:	PHILLIP LAWING
Credential	:
Telephone Number	:	228-596-2449

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	11/11/2020

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