NPIMap

Organization Active NPI

Serenity Lodge, Inc

  • Substance Abuse Rehabilitation Facility
  • Lake Arrowhead, CA
National Provider Identifier
1043916273
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
SERENITY LODGE, INC
Practice address
345 Ca-173
Lake Arrowhead, CA 92352
Phone
(657) 304-0103
NPI assigned
Jan 31, 2023
Last updated
Oct 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gilbert Yates
Title
Contract Manager
Phone
(877) 262-7803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

345 Ca-173
Lake Arrowhead, CA 92352

Mailing address

PO Box 2895
Lake Arrowhead, CA 92352-2895

National Provider Directory

National Provider Directory
Tax ID family
Serenity Lodge Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1043916273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2895",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923522895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 CA-173",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "92352",
            "telephone_number": "657-304-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY LODGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "YATES",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_title_or_position": "CONTRACT MANAGER",
        "authorized_official_telephone_number": "877-262-7803"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Arrowhead, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.