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General NPI Number Information
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NPI Number | 1972046555
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Entity Type | Organization
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Legal Business Name | SERENITY HOUSE DETOX
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1780 NW 52ND AVE
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City | LAUDERHILL
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State | FL
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Zip | 33313-7811
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Country | US
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Telephone | 888-960-7148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2070
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City | HALLANDALE
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State | FL
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Zip | 33008-2070
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERICA SHAPIRO
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Credential |
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Telephone | 305-761-7318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | FL
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