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General NPI Number Information
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NPI Number | 1497289979
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Entity Type | Organization
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Legal Business Name | SERENITY BEHAVIORAL HEALTH SERVICE LLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 2000 CRESWELL AVE
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City | SHREVEPORT
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State | LA
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Zip | 71104-2202
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Country | US
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Telephone | 318-635-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 4350 GREENWOOD RD
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City | SHREVEPORT
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State | LA
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Zip | 71109-5610
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Country | US
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Telephone | 318-635-1414
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Fax | 318-636-6107
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS CHERYL DENISE JOHNSON
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Credential |
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Telephone | 318-635-1414
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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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