NPIMap

Organization Active NPI

Serenity Psychiatric Outpatient, LLC

Doing business as Colonial Haven Rehab

  • Clinical Social Worker
  • Greensboro, AL
National Provider Identifier
1083903298
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SERENITY PSYCHIATRIC OUTPATIENT, LLC
Doing business as
Colonial Haven Rehab
Practice address
616 Armory St
Greensboro, AL 36744-2110
Phone
(334) 624-3360
NPI assigned
Mar 29, 2011
Last updated
Mar 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Authorized official

Name
Debbie White
Title
Accounts Payable
Phone
(601) 276-3909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

616 Armory St
Greensboro, AL 36744-2110

Mailing address

4109 Highway 98 W
Summit, MS 39666-9132

Other names 1

  • COLONIAL HAVEN REHAB Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110419000203 AL Part B Supplier - Clinic/Group Practice 7911181805 Receives reassigned benefits from 1 practitioner
Practice locations: Pleasant Grove, AL; Tuscaloosa, AL; Greensboro, AL; Alabaster, AL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Colonial Haven Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1083903298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 HIGHWAY 98 W",
            "city": "SUMMIT",
            "state": "MS",
            "postal_code": "396669132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 ARMORY ST",
            "city": "GREENSBORO",
            "state": "AL",
            "postal_code": "367442110",
            "telephone_number": "334-624-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY PSYCHIATRIC OUTPATIENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "ACCOUNTS PAYABLE",
        "authorized_official_telephone_number": "601-276-3909"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLONIAL HAVEN REHAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.