Healthcare Provider Details

I. General information

NPI: 1255197406
Provider Name (Legal Business Name): SERENITY HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE LL1
PHOENIX AZ
85006-2606
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE LL1
PHOENIX AZ
85006-2606
US

V. Phone/Fax

Practice location:
  • Phone: 602-317-1006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DESTINY NICOLE NORA CARTER
Title or Position: ADMIN
Credential:
Phone: 602-317-1006