Healthcare Provider Details

I. General information

NPI: 1114432739
Provider Name (Legal Business Name): SERENITY NOW HEALTHCARE OF MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 VIRGINIA ST
BAY ST LOUIS MS
39520-7010
US

IV. Provider business mailing address

5011 VIRGINIA ST
BAY ST LOUIS MS
39520-7010
US

V. Phone/Fax

Practice location:
  • Phone: 888-371-1924
  • Fax: 888-371-1924
Mailing address:
  • Phone: 888-371-1924
  • Fax: 888-371-1924

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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP LAWING
Title or Position: OWNER
Credential:
Phone: 228-596-2449