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General NPI Number Information
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NPI Number | 1275388761
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Entity Type | Organization
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Legal Business Name | SERENITY PARK OPERATIONS LLC
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 2711 W ROOSEVELT RD
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City | LITTLE ROCK
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State | AR
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Zip | 72204-5668
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Country | US
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Telephone | 718-570-6018
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Fax |
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Provider Business Mailing Address
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Address Line | 180 SYLVAN AVE STE 202
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2512
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Country | US
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Telephone | 718-570-6018
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. DANIEL MANDELBAUM
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Credential |
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Telephone | 718-570-6018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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