Healthcare Provider Details

I. General information

NPI: 1679339469
Provider Name (Legal Business Name): SERENITY TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BUTTERFLY LN
FREDERICK MD
21703-5971
US

IV. Provider business mailing address

5703 INDUSTRY LN UNIT 103-104
FREDERICK MD
21704-7263
US

V. Phone/Fax

Practice location:
  • Phone: 240-457-8874
  • Fax: 301-898-2640
Mailing address:
  • Phone: 301-898-2627
  • Fax: 301-898-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEAN NICHOLSON
Title or Position: CEO/OWNER
Credential:
Phone: 240-457-8874