NPIMap

Organization Active NPI

Serenity Manor

Doing business as Serenity Haven

  • Substance Abuse Rehabilitation Facility
  • Mora, MN
National Provider Identifier
1689928319
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1064343 Issued in MN
Legal business name
SERENITY MANOR
Doing business as
Serenity Haven
Practice address
206 Maple Ave E
Mora, MN 55051-1311
Phone
(320) 679-3580
Fax
(320) 679-3579
NPI assigned
Nov 2, 2012
Last updated
Jun 6, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

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

Authorized official

Name
Mrs. Brittany Anne Rollins
Title
Executive Director
Phone
(320) 679-1936

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 1064343 MN Primary

Addresses

Primary practice location

206 Maple Ave E
Mora, MN 55051-1311

Mailing address

206 Maple Ave E
Mora, MN 55051-1311
Phone (320) 679-3580

Other names 1

  • Serenity Haven Doing business as

National Provider Directory

National Provider Directory

Locations

206 Maple Ave E
Mora, MN 55051
Phone (320) 209-1941

Practitioners & affiliated clinicians

Practitioners 4

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": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370476800000",
    "number": "1689928319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 MAPLE AVE E",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511311",
            "telephone_number": "320-679-3580",
            "fax_number": "320-679-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MAPLE AVE E",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511311",
            "telephone_number": "320-679-3580",
            "fax_number": "320-679-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2013-06-06",
        "status": "A",
        "authorized_official_last_name": "ROLLINS",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-679-1936",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1064343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mora, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.