Provider Demographics
NPI:1255144317
Name:SERENITY THERAPY CENTER LLC
Entity type:Organization
Organization Name:SERENITY THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAFIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-732-2594
Mailing Address - Street 1:1129 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-4402
Mailing Address - Country:US
Mailing Address - Phone:763-732-2594
Mailing Address - Fax:
Practice Address - Street 1:1129 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-4402
Practice Address - Country:US
Practice Address - Phone:763-732-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health