NPIMap

Organization Active NPI

Serenity Path Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooten, MN
National Provider Identifier
1174926844
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1074051-1-CDT Issued in MN
Legal business name
SERENITY PATH INC.
Practice address
145 Central Ave S
Box 324
Brooten, MN 56316-4748
Phone
(320) 243-3379
NPI assigned
Oct 8, 2014
Last updated
Oct 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Authorized official

Name
William Madigan, M.S., LADC
Title
Executive Director
Phone
(320) 243-3379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1074051-1-CDT MN Primary

Addresses

Primary practice location

145 Central Ave S
Box 324
Brooten, MN 56316-4748

Mailing address

117 W James St
Box 3
Paynesville, MN 56362-1216
Phone (320) 243-3379

Other names 1

  • Serenity Path Brooten Other name

National Provider Directory

National Provider Directory
Tax ID family
Serenity Path Brooten2 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.

Locations

145 Central Ave S
#324
Brooten, MN 56316
Phone (320) 243-3379

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": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1174926844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W JAMES ST",
            "address_2": "BOX 3",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563621216",
            "telephone_number": "320-243-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 CENTRAL AVE S",
            "address_2": "BOX 324",
            "city": "BROOTEN",
            "state": "MN",
            "postal_code": "563164748",
            "telephone_number": "320-243-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY PATH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "MADIGAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-243-3379",
        "authorized_official_credential": "M.S., LADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1074051-1-CDT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Path Brooten",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brooten, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.