Healthcare Provider Details

I. General information

NPI: 1578256665
Provider Name (Legal Business Name): JV SERENITY IOP PRINCETON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 QUAKERBRIDGE RD
PRINCETON JCT NJ
08550-5243
US

IV. Provider business mailing address

PO BOX 31298
TAMPA FL
33631-3298
US

V. Phone/Fax

Practice location:
  • Phone: 855-219-1877
  • Fax: 954-337-6238
Mailing address:
  • Phone: 855-219-1877
  • Fax: 954-337-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEJA GILBERT
Title or Position: CEO
Credential: PHD, LMHC, LPC
Phone: 855-219-1877