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General NPI Number Information
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NPI Number | 1871021188
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Entity Type | Organization
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Legal Business Name | SIERRA SERENITY PROVIDERS, LLC.
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 515 E GAULT WAY
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City | SPARKS
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State | NV
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Zip | 89431-2482
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Country | US
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Telephone | 775-432-1035
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Fax | 775-384-6685
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Provider Business Mailing Address
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Address Line | PO BOX 50174
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City | SPARKS
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State | NV
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Zip | 89435-0174
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Country | US
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Telephone | 775-432-1035
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Fax | 775-384-6685
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Authorized Official
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Title or Position | OWNER
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Name | ERICA CHRISTINE YOUNG
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Credential |
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Telephone | 775-432-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NV
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