Provider Demographics
NPI:1861224511
Name:SERENITY CARE
Entity type:Organization
Organization Name:SERENITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NKUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-455-4874
Mailing Address - Street 1:135 NW LINNEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6248
Mailing Address - Country:US
Mailing Address - Phone:469-455-4874
Mailing Address - Fax:
Practice Address - Street 1:135 NW LINNEMAN AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6248
Practice Address - Country:US
Practice Address - Phone:469-455-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility