Healthcare Provider Details

I. General information

NPI: 1497328496
Provider Name (Legal Business Name): SERENITY COMMUNITY MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12542 PINES BLVD
PEMBROKE PINES FL
33027-1713
US

IV. Provider business mailing address

12542 PINES BLVD
PEMBROKE PINES FL
33027-1713
US

V. Phone/Fax

Practice location:
  • Phone: 954-391-9478
  • Fax: 954-367-6684
Mailing address:
  • Phone: 954-391-9478
  • Fax: 954-367-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YADIRA SANTANA
Title or Position: C.E.O
Credential:
Phone: 954-391-9478