MEDICARE: SERENITY RECOVERY SERVICES

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	174400000X	Specialist

General Provider Information

NPI Number	:	1386110955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	93 OLD YORK RD # 1-526
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-3925
Country	:	US
Telephone Number	:	267-361-8308
Fax Number	:	215-701-5888

Provider Business Practice Location Address
First Line	:	8410 BUSTLETON AVE STE 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1924
Country	:	US
Telephone Number	:	267-361-8308
Fax Number	:	215-701-5888

Authorized Official
Title or Position	:	OWNER
Name	:	TAHIRA DOCKERY
Credential	:	CRNP
Telephone Number	:	267-291-4513

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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Directions to “SERENITY RECOVERY SERVICES ” Practice Location

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