SERENITY PARK RECOVERY CLINIC (NPI# 1407407570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407407570 |
| Entity Type | Organization |
| Organization Name | SERENITY PARK RECOVERY CLINIC |
| Practice Address |
2711 W Roosevelt Rd Little Rock AR 72204-5668 |
| Mailing Address |
2801 W Roosevelt Rd Little Rock AR 72204-5655 |
| Practice Telephone | 5013130066 |
| Practice Fax Number | 5013132059 |
| Mailing Telephone | 5013130066 |
| Mailing Fax Number | 5013132059 |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2019-09-20 |
| Authorized Official Name | TARA TINNIN (CEO) |
| Authorized Official Telephone | 5013130066 |
| Is Organization Subpart | Y |
| Parent Organization Name | SERENITY PARK TREATMENT CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Street Address |
2711 W ROOSEVELT RD |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72204-5668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669952966 | Shane Wilson | Non-emergency Medical Transport (VAN) | 1522 S Tyler St, Little Rock, AR 72204 | 2018-08-16 |
| 1659858348 | Poplar Grove Operations LLC | Skilled Nursing Facility | 7801 Kanis Road, Little Rock, AR 72204 | 2018-07-25 |
| 1275056004 | University of Arkansas for Medical Sciences | Orthopaedic Surgery | 108015 Colonel Glenn Rd, Little Rock, AR 72204 | 2017-07-24 |
| 1265954820 | Marilyn Marie Lynch | Registered Nurse | 7723 Colonel Glenn Road, Little Rock, AR 72204 | 2017-07-14 |
| 1962852954 | Arkansas Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 1122 S. University Ave, Little Rock, AR 72204 | 2016-06-21 |
| 1841607751 | Charity Gillespie | Registered Nurse | 5210 Timberland Dr, Little Rock, AR 72204 | 2014-07-14 |
| 1043625221 | Interventional Surgery Institute of Little Rock, LLC | Clinic/Center | 9 Freeway Drive, Suite A, Little Rock, AR 72204 | 2014-06-25 |
| 1548696065 | Jamie Washington | Prosthetic/Orthotic Supplier | 4701 Westwood Ave, Little Rock, AR 72204 | 2013-09-16 |
| 1124468913 | Stephanie Rachelle Jez | Genetic Counselor, MS | 5800 West 10th Street, Freeway Medical Building, Suite 7-500, Little Rock, AR 72204 | 2013-06-26 |
| 1336492321 | Alton Charles Phillips Sr. | Counselor | 4400shuffield Drive, Little Rock, AR 72204 | 2012-10-16 |
| Find all providers in zip 72204 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346642634 | Addiction & Mental Health Services, LLC | Clinic/Center | 11215 Hermitage Rd Ste 204, Little Rock, AR 72211-3864 | 2014-09-18 |
| 1255977054 | University of Arkansas for Medical Sciences | Clinic/Center | 4224 Shuffield Drive, Little Rock, AR 72205-7101 | 2019-11-27 |
| 1447780952 | Arc Rehabilitation Center Pa | Clinic/Center | 1 Lile Ct Ste 103, Little Rock, AR 72205-6239 | 2017-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306484860 | Eaglecrest Recovery LLC | Clinic/Center | 1106 Sw 2nd St, Bentonville, AR 72712-5026 | 2019-12-16 |
| 1447723143 | Sozo Recovery Centers Inc | Clinic/Center | 243 Nathan Ter, Jessieville, AR 71949-9289 | 2019-01-04 |
| 1942403696 | Gateway House Inc | Clinic/Center | 3900 Armour Avenue, Fort Smith, AR 72904-4317 | 2007-06-08 |
| 1285273219 | True Self Recovery LLC | Clinic/Center | 1104 N 2nd St, Rogers, AR 72756-2834 | 2019-12-20 |
| 1902443229 | Quapaw House | Clinic/Center | 615 W Grand Ave, Hot Springs, AR 71901-3927 | 2019-12-05 |
| 1013461987 | Jefferson Comprehensive Counseling Associates | Clinic/Center | 2304 W 29th Ave, Pine Bluff, AR 71603-5005 | 2016-08-09 |
| City | LITTLE ROCK |
| Zip Code | 72204 |
Please comment or provide details below to improve the information on SERENITY PARK RECOVERY CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.