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General NPI Number Information
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NPI Number | 1689196578
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Entity Type | Organization
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Legal Business Name | SERENITY TREATMENT AND COUNSELING CENTER INC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 19408 NORTH CREEK DRIVE
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City | LYNWOOD
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State | IL
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Zip | 60411-8649
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Country | US
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Telephone | 708-251-3952
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Fax | 708-251-5496
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Provider Business Mailing Address
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Address Line | 10641 S HALE AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60643-2700
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Country | US
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Telephone | 800-881-2740
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Fax | 888-557-5031
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Authorized Official
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Title or Position | CONSULTANT/ACCOUNTANT
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Name | MR. KARL MICHAEL PERTEET
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Credential |
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Telephone | 800-881-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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