Provider Demographics
NPI:1548000268
Name:SERENITY BAY HEALTH PLLC
Entity type:Organization
Organization Name:SERENITY BAY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-266-3188
Mailing Address - Street 1:1426 STRAITS DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8705
Mailing Address - Country:US
Mailing Address - Phone:989-266-3188
Mailing Address - Fax:
Practice Address - Street 1:1426 STRAITS DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8705
Practice Address - Country:US
Practice Address - Phone:989-266-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY BAY HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)