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General NPI Number Information
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NPI Number | 1497397723
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Entity Type | Organization
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Legal Business Name | SERENITY WELLNESS, LLC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 524 CLEVELAND BLVD STE 230
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City | CALDWELL
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State | ID
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Zip | 83605-4076
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Country | US
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Telephone | 208-800-0588
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Fax | 208-800-0599
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Provider Business Mailing Address
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Address Line | 524 CLEVELAND BLVD STE 230
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City | CALDWELL
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State | ID
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Zip | 83605-4076
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Country | US
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Telephone | 208-800-0588
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Fax | 208-800-0599
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AARON ELIAS ST.GEORGE
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Credential | B.S., ICADC
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Telephone | 208-800-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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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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