MEDICARE: SERENITY GROUP 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750090080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY GROUP LLC

Provider Business Mailing Address
First Line	:	2373 SAG HARBOR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5079
Country	:	US
Telephone Number	:	786-355-3712
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 SAG HARBOR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5079
Country	:	US
Telephone Number	:	786-355-3712
Fax Number	:

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	KENNY CASTILLO CABRERA
Credential	:
Telephone Number	:	786-355-3712

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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Directions to “SERENITY GROUP LLC ” Practice Location

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