Serenity Lodge, Inc
Organization Active NPI Substance Abuse Rehabilitation Facility · Lake Arrowhead, CA
NPI 1043780109 · NPPES record last updated Dec 3, 2018
Key facts
- NPI
- 1043780109
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- SERENITY LODGE, INC
- Practice address
- 986 Meadow Brook Road
Lake Arrowhead, CA 92352-9235 - Phone
- (909) 693-5127
- NPI assigned
- Dec 3, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- SERENITY LODGE, INC
Authorized official
- Name
- Matthew Joseph Baldo
- Title
- Compliance Manager
- Phone
- (909) 693-5127
Corporate family (same tax ID) 10
National Provider Directory
- Tax ID family
- Serenity Lodge Inc
- Part of
- Serenity Lodge Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
986 Meadow Brook Road
Lake Arrowhead, CA 92352-9235
Mailing address
PO Box 2895
Lake Arrowhead, CA 92352-2895
Phone (909) 693-5127
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 360091AP | Other | CA | STATE LICENSE |
Other providers in Lake Arrowhead, CA
- San Bernardino Mountains Community Hospital
- San Bernardino Mountains Community Hospital District
- San Bernardino Mountains Community Hospital District
- San Bernardino Mountains Community Hospital District
- San Bernardino Mountains Community Hospital District
- Serenity Lodge, Inc
- Serenity Lodge, Inc
- Serenity Lodge, Inc
- Serenity Lodge, Inc
- Serenity Lodge, Inc
All providers in Lake Arrowhead, CA · Substance Abuse Rehabilitation Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.