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General NPI Number Information
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NPI Number | 1285170670
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Entity Type | Organization
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Legal Business Name | SERENITY INFUSION CENTER OF SOUTH JERSEY, LLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 110 AMERICAN BLVD SUITE 6
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1767
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Country | US
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Telephone | 856-344-7982
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Fax | 856-344-7984
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Provider Business Mailing Address
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Address Line | 614 S WHITE HORSE PIKE
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City | SOMERDALE
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State | NJ
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Zip | 08083-1246
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Country | US
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Telephone | 856-344-7982
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Fax | 856-344-7984
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. LANETTE KEETON
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Credential |
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Telephone | 856-344-7982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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