Healthcare Provider Details

I. General information

NPI: 1730051533
Provider Name (Legal Business Name): SERENITY AND GRACE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E 45TH ST STE 310
CLEVELAND OH
44127-1091
US

IV. Provider business mailing address

3100 E 45TH ST STE 310
CLEVELAND OH
44127-1091
US

V. Phone/Fax

Practice location:
  • Phone: 347-456-4647
  • Fax:
Mailing address:
  • Phone: 347-456-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEE
Title or Position: CEO
Credential:
Phone: 347-456-4647