Healthcare Provider Details

I. General information

NPI: 1043717937
Provider Name (Legal Business Name): SERENITY HILLS LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONE SHANNON RD
WHEELING WV
26003-6742
US

IV. Provider business mailing address

220 BETHANY PIKE
WHEELING WV
26003-1608
US

V. Phone/Fax

Practice location:
  • Phone: 304-277-4657
  • Fax:
Mailing address:
  • Phone: 304-281-0474
  • Fax: 304-905-9333

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: SHARON TRAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-277-4657