Healthcare Provider Details

I. General information

NPI: 1639341332
Provider Name (Legal Business Name): SERENITY HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E GRAND AVE
CHIPPEWA FALLS WI
54729-2632
US

IV. Provider business mailing address

205 E GRAND AVE
CHIPPEWA FALLS WI
54729-2632
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-8468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: JOSEPH SUMNER
Title or Position: DIRECTOR
Credential:
Phone: 715-723-8468