Healthcare Provider Details

I. General information

NPI: 1629405741
Provider Name (Legal Business Name): SERENITY HUMAN SERVICE COORDINATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 3RD ST
IDAHO FALLS ID
83401-3953
US

IV. Provider business mailing address

4254 E SUNNYSIDE RD
AMMON ID
83406-8033
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0169
  • Fax: 208-542-5152
Mailing address:
  • Phone: 208-403-2825
  • Fax: 208-542-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLCPC4472
License Number StateID

VIII. Authorized Official

Name: MRS. ARACELLI RODRIGUEZ
Title or Position: OWNER
Credential: MSW
Phone: 208-403-2825