Healthcare Provider Details

I. General information

NPI: 1750148995
Provider Name (Legal Business Name): SERENITY SPRINGS HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RIDGEWAY ST STE F
HOT SPRINGS AR
71901-7157
US

IV. Provider business mailing address

220 CARL DR
HOT SPRINGS AR
71913-6236
US

V. Phone/Fax

Practice location:
  • Phone: 501-762-1123
  • Fax:
Mailing address:
  • Phone: 501-276-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BARELA
Title or Position: CREDENTIALING CONSULTANT
Credential:
Phone: 719-717-7555