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General NPI Number Information
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NPI Number | 1629405741
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Entity Type | Organization
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Legal Business Name | SERENITY HUMAN SERVICE COORDINATION LLC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 560 3RD ST
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3953
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Country | US
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Telephone | 208-529-0169
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Fax | 208-542-5152
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Provider Business Mailing Address
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Address Line | 4254 E SUNNYSIDE RD
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City | AMMON
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State | ID
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Zip | 83406-8033
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Country | US
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Telephone | 208-403-2825
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Fax | 208-542-5152
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ARACELLI RODRIGUEZ
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Credential | MSW
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Telephone | 208-403-2825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCPC4472
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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