Healthcare Provider Details

I. General information

NPI: 1245967751
Provider Name (Legal Business Name): SERENITY MENTAL HEALTH AND REHABILITATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DEEP VALLEY DR STE 200
ROLLING HILLS ESTATES CA
90274-3614
US

IV. Provider business mailing address

609 DEEP VALLEY DR STE 200
ROLLING HILLS ESTATES CA
90274-3614
US

V. Phone/Fax

Practice location:
  • Phone: 781-205-9944
  • Fax:
Mailing address:
  • Phone: 781-205-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IRINE N ACHUAMANG
Title or Position: OWNER OF ENTITY
Credential: MSN, PMHNP-BC
Phone: 781-205-9944