Provider Demographics
NPI:1669265815
Name:SERENITY SHIFT WELLNESS CENTER
Entity type:Organization
Organization Name:SERENITY SHIFT WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-226-2679
Mailing Address - Street 1:2450 HOLLYWOOD BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6628
Mailing Address - Country:US
Mailing Address - Phone:786-226-2679
Mailing Address - Fax:954-416-7437
Practice Address - Street 1:2450 HOLLYWOOD BLVD STE 701
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6628
Practice Address - Country:US
Practice Address - Phone:786-226-2679
Practice Address - Fax:954-416-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No302R00000XManaged Care OrganizationsHealth Maintenance Organization