Healthcare Provider Details

I. General information

NPI: 1336912682
Provider Name (Legal Business Name): SERNA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 BARBARA LOOP SE STE A
RIO RANCHO NM
87124-1011
US

IV. Provider business mailing address

4001 OFFICE COURT DR STE 201
SANTA FE NM
87507-4936
US

V. Phone/Fax

Practice location:
  • Phone: 505-305-4949
  • Fax:
Mailing address:
  • Phone: 505-207-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA PRATT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 505-207-8929