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General NPI Number Information
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NPI Number | 1790577245
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Entity Type | Organization
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Legal Business Name | CLUB SERENITY INC
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 702 FALLOWFIELD AVE
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City | CHARLEROI
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State | PA
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Zip | 15022-1909
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Country | US
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Telephone | 724-797-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 702 FALLOWFIELD AVE
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City | CHARLEROI
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State | PA
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Zip | 15022-1909
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Country | US
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Telephone | 724-797-2221
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JOSEPH ROBERT PAGANO
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Credential | DSW, LSW, CRS
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Telephone | 724-797-2221
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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 | 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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Taxonomy #3
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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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