Healthcare Provider Details

I. General information

NPI: 1598534828
Provider Name (Legal Business Name): SERENITY RECOVERY AND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CABOT BLVD STE 300
MANSFIELD MA
02048-1183
US

IV. Provider business mailing address

11 ROBERT TONER BLVD STE 5
ATTLEBORO FALLS MA
02763-1156
US

V. Phone/Fax

Practice location:
  • Phone: 508-213-1326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAYWELL TEDOE
Title or Position: OWNER
Credential: NP
Phone: 401-419-2106