MEDICARE: SERENITY OUTREACH

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1447528948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY OUTREACH

Provider Business Mailing Address
First Line	:	824 EAST DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-8418
Country	:	US
Telephone Number	:	405-557-1910
Fax Number	:	405-557-0811

Provider Business Practice Location Address
First Line	:	824 EAST DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-8418
Country	:	US
Telephone Number	:	405-557-1910
Fax Number	:	405-557-0811

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RONALD SCOTT
Credential	:
Telephone Number	:	405-557-1910

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/12/2011

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Directions to “SERENITY OUTREACH ” Practice Location

Language	Start Address	Practice Location

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