Healthcare Provider Details

I. General information

NPI: 1457914913
Provider Name (Legal Business Name): SERENITY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E 10 MILE RD STE 135
EASTPOINTE MI
48021-3349
US

IV. Provider business mailing address

17200 E 10 MILE RD STE 135
EASTPOINTE MI
48021-3349
US

V. Phone/Fax

Practice location:
  • Phone: 586-552-5826
  • Fax: 586-252-2960
Mailing address:
  • Phone: 586-552-5826
  • Fax: 586-252-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TREVION FRIERSON
Title or Position: OWNER
Credential:
Phone: 586-552-5826