MEDICARE: SERENITY COMMUNITY MENTAL HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740890607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COMMUNITY MENTAL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	9923 SW 147TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-1634
Country	:	US
Telephone Number	:	786-205-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 250
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3014
Country	:	US
Telephone Number	:	786-205-4515
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	KLEYDSON NEVES DA SILVA
Credential	:
Telephone Number	:	786-205-4515

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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