Provider Demographics
NPI:1730943218
Name:SERENITY HILLS BEHAVIORAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:SERENITY HILLS BEHAVIORAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEKESSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS-CARBY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:860-655-4986
Mailing Address - Street 1:566 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2920
Mailing Address - Country:US
Mailing Address - Phone:860-655-4986
Mailing Address - Fax:
Practice Address - Street 1:566 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2920
Practice Address - Country:US
Practice Address - Phone:860-655-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty