Provider Demographics
NPI:1447702139
Name:SERENE SPIRIT MENTAL HEALTH CARE, LLC
Entity type:Organization
Organization Name:SERENE SPIRIT MENTAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NASBY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC
Authorized Official - Phone:507-322-6564
Mailing Address - Street 1:382 NORSEMAN CT NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2430
Mailing Address - Country:US
Mailing Address - Phone:507-254-5208
Mailing Address - Fax:507-322-6566
Practice Address - Street 1:315 ELTON HILLS DR NW
Practice Address - Street 2:STE 201
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2988
Practice Address - Country:US
Practice Address - Phone:507-322-6564
Practice Address - Fax:507-322-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNS0482364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty