NPIMap

Organization Active NPI

Serenity Lodge, Inc

  • Substance Abuse Rehabilitation Facility
  • Lake Arrowhead, CA
National Provider Identifier
1992294813
Registry record updated May 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
360091AP Issued in CA
Legal business name
SERENITY LODGE, INC
Practice address
1000 Pine Court
Lake Arrowhead, CA 92352
Phone
(909) 693-5127
NPI assigned
May 7, 2018
Organization subpart
Yes
Parent organization
SERENITY LODGE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2018

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

Authorized official

Name
Matthew Joseph Baldo
Title
Compliance Manager
Phone
(909) 693-5127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 360091AP CA Primary

Addresses

Primary practice location

1000 Pine Court
Lake Arrowhead, CA 92352

Mailing address

PO Box 2895
Lake Arrowhead, CA 92352-2895
Phone (909) 693-5127

National Provider Directory

National Provider Directory
Tax ID family
Serenity Lodge Inc11 organizations share this tax ID, including this one
Part of
Serenity Lodge Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525737600000",
    "number": "1992294813",
    "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": "909-693-5127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PINE COURT",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "92352",
            "telephone_number": "909-693-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY LODGE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SERENITY LODGE, INC",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-08",
        "status": "A",
        "authorized_official_last_name": "BALDO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "909-693-5127"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "360091AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Arrowhead, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; 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.