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General NPI Number Information
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NPI Number | 1336808823
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Entity Type | Organization
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Legal Business Name | SERENITY BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/11/2021
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Last Update Date | 12/11/2021
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Provider Practice Location Address
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Address Line | 100 NE 15TH ST STE 103B
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City | HOMESTEAD
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State | FL
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Zip | 33030-4564
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Country | US
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Telephone | 786-601-9007
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Fax | 786-272-0463
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Provider Business Mailing Address
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Address Line | 100 NE 15TH ST STE 103B
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City | HOMESTEAD
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State | FL
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Zip | 33030-4564
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Country | US
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Telephone | 786-601-9007
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Fax | 786-272-0463
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TOCOVIA C WHIPPLE
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Credential |
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Telephone | 786-601-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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