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General NPI Number Information
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NPI Number | 1669878740
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Entity Type | Organization
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Legal Business Name | SERENITY HOME LLC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 3284 BULLWINKLE DR
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City | RENO
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State | NV
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Zip | 89512-1135
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Country | US
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Telephone | 775-229-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 3284 BULLWINKLE DR
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City | RENO
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State | NV
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Zip | 89512-1135
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Country | US
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Telephone | 775-229-2036
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NEDIRA ABUBAKER
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Credential |
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Telephone | 775-971-8081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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