Serenity Springs LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

0764AD596801 Issued in FL

Legal business name

SERENITY SPRINGS LLC

Practice address

1555 Cow Creek Rd
Edgewater, FL 32132-6915

Phone

(386) 423-4540

NPI assigned

Jun 21, 2013

Last updated

Jun 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin Pike

Title

Director of Operations

Phone

(386) 423-4540

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194164277. Details of each certification follow.

• CCN 693200 Comprehensive outpatient rehabilitation facility · Active · Name & address match · Details

Comprehensive outpatient rehabilitation facility certification: CCN 693200

Legal name

SERENITY SPRINGS RECOVERY CENTER

Certification status

Active

Provider type (POS)

Comprehensive outpatient rehabilitation facility

Participating since

Apr 15, 2022

Last certification

Apr 15, 2022

Ownership / control type

Proprietary

Facility address

1555 Cow Creek Rd
Edgewater, FL 32132

Locations

Networks

• HealthSun Health Plans Network

Practitioners 3

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.

• Edda Casanova, MD

  • Child & Adolescent Psychiatry Physician
  • Deland, FL
  • NPI 1215922695
  NPD (past)
• Jose Antonio Vera, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Sanford, FL
  • NPI 1669702270
  NPD (past)
• Victoria Susan Waicus, ARNP

  • Family Nurse Practitioner
  • Edgewater, FL
  • NPI 1275159733
  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1194164277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 COW CREEK RD",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321326915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 COW CREEK RD",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321326915",
            "telephone_number": "386-423-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SPRINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "PIKE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "386-423-4540"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": "0764AD596801",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "69-3200",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS",
            "identifier": "69-3200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113733600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Schroeder
• Kyra Schweizer
• Amber Nichole Scott, D.C.
• Sea Change Counseling LLC
• Kami Teresa Seifert, FNP-C
• Antoinise Servius
• Sharon L Shelton, DO
• Candy Shields
• Shoreline Medical Addiction Treatment LLC
• Shores Medical PA

• Substance Abuse Rehabilitation Facility in Edgewater, FL
• Providers in Edgewater, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.