Serenity Lodge Inc

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SERENITY LODGE INC

Practice address

27175 State Highway 189
Unit a
Blue Jay, CA 92317

Phone

(949) 244-2279

NPI assigned

Aug 13, 2026

Organization subpart

Yes

Parent organization

SERENITY LODGE INCAs reported in NPPES

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

Authorized official

Name

Jesse Lee Kellert

Title

Ceo

Phone

(949) 244-2279

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1786579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1831014166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2895",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923522895",
            "telephone_number": "949-244-2279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27175 STATE HIGHWAY 189",
            "address_2": "UNIT A",
            "city": "BLUE JAY",
            "state": "CA",
            "postal_code": "92317",
            "telephone_number": "949-244-2279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY LODGE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SERENITY LODGE INC",
        "enumeration_date": "2026-08-13",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "KELLERT",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-244-2279"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nurses for Safe Access
• Pamela Perlmutter
• Meaghan Plooy, PHARMACY TECHNICIAN
• Lisa Ann Reavley, LMT
• Jill Marie Rhoades, LVN
• Tarah Jeanette-Gonzalez Sparkman, DPT
• Duy Nguyen Tang, RPH
• Thrifty Payless Inc
• Thrify Payless Inc
• Terrance Tolbirt, D.C.

• All providers in Blue Jay, CA
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.