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General NPI Number Information
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NPI Number | 1518839562
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Entity Type | Organization
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Legal Business Name | JL SERENITY CENTER LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3333 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-4613
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Country | US
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Telephone | 502-698-4764
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-4613
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Country | US
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Telephone | 502-698-4764
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EINAR SERRANO REYES
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Credential |
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Telephone | 502-698-4764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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