Provider Demographics
NPI:1205459880
Name:SERENITY WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:SERENITY WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJANA
Authorized Official - Middle Name:DEVO
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-987-3622
Mailing Address - Street 1:PO BOX 230095
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-0095
Mailing Address - Country:US
Mailing Address - Phone:503-987-3622
Mailing Address - Fax:503-987-3022
Practice Address - Street 1:12570 SW 69TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2552
Practice Address - Country:US
Practice Address - Phone:503-987-3622
Practice Address - Fax:503-987-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service