Healthcare Provider Details

I. General information

NPI: 1558192203
Provider Name (Legal Business Name): SERENITY FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 ARGENTINE ST
GEORGETOWN CO
80444
US

IV. Provider business mailing address

PO BOX 187
GEORGETOWN CO
80444-0187
US

V. Phone/Fax

Practice location:
  • Phone: 720-730-7530
  • Fax:
Mailing address:
  • Phone: 303-604-4060
  • Fax: 720-502-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BO MACASOVIC
Title or Position: MANAGER
Credential:
Phone: 303-604-4060