Serenity Ave. Integrative Services LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

SERENITY AVE. INTEGRATIVE SERVICES LLC

Practice address

17330 Northland Park CT
Southfield, MI 48075-4318

Phone

(248) 422-1333

NPI assigned

Oct 20, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Karla Jordan, PMHNP

Title

Ceo

Phone

(248) 422-1333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604102400000",
    "number": "1255930491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29494 ASHLAND AVE APT 301",
            "city": "HARRISON TOWNSHIP",
            "state": "MI",
            "postal_code": "480455742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-422-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY AVE. INTEGRATIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-31",
        "certification_date": "2020-10-31",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-422-1333",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2020; 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.