Serenity House Afch

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

6906590 Issued in FL

Legal business name

SERENITY HOUSE AFCH

Practice address

943 62ND Ter S
St Petersburg, FL 33705-5818

Phone

(727) 906-9405

Fax

(727) 906-9405

NPI assigned

Jul 16, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Camilla Lee Bridgeman, PCT

Title

Owner

Phone

(727) 906-9405

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Camilla Bridgeman Other name

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1205277407",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "943 62ND TERRACE S.",
            "city": "ST. PETERSBURG",
            "state": "USA",
            "postal_code": "33705",
            "telephone_number": "727-906-9405",
            "fax_number": "727-906-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 62ND TER S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337055818",
            "telephone_number": "727-906-9405",
            "fax_number": "727-906-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY HOUSE AFCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "BRIDGEMAN",
        "authorized_official_first_name": "CAMILLA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-906-9405",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PCT"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "FL",
            "license": "6906590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5766SPICES",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VACATION51",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camilla Bridgeman",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sequential Genetics LLC
• Sequoia Behavioral Therapy
• Sherif M. Serag, M.D.
• Jessie Bardin Sereda, ARNP
• Serenity Clinic LLC
• Serenity Love and Care LLC
• Serenity Xcelled Counseling LLC
• Miguel Serrano, MD
• Rachel Marie Morris Sessler, MD
• Vikas S Sethi, DO

• Physical Disabilities Residential Treatment Facility in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Physical Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.