MEDICARE: SERENITY ONE BEHAVIORAL HEALTH CARE, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265959209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY ONE BEHAVIORAL HEALTH CARE, LLC.

Provider Business Mailing Address
First Line	:	2801 S VALLEY VIEW BLVD STE 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0176
Country	:	US
Telephone Number	:	702-629-5815
Fax Number	:	725-629-5815

Provider Business Practice Location Address
First Line	:	2801 S VALLEY VIEW BLVD STE 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0176
Country	:	US
Telephone Number	:	702-629-5815
Fax Number	:	725-629-5815

Authorized Official
Title or Position	:	OWNER
Name	:	BRIDGET ESPY
Credential	:
Telephone Number	:	702-629-5815

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	11/20/2018

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