SERENITY LANE (NPI# 1710330386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710330386 |
| Entity Type | Organization |
| Organization Name | SERENITY LANE |
| Practice Address |
2575 Nw Kline St Roseburg OR 97471-8827 |
| Practice Telephone | 5416733504 |
| Practice Fax Number | 5416734724 |
| Mailing Telephone | 5416733504 |
| Mailing Fax Number | 5416734724 |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |
| Authorized Official Name | TONY HAYNES (CLINIC COORDINATOR) |
| Authorized Official Telephone | 5416733504 |
| Authorized Official Credential | BA, CADC LL |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
120948 | OR | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619429396 | Serenity Lane | Substance Abuse Rehabilitation Facility | 304 Dartmoor Drive, Eugene, OR 97401 | 2016-10-28 |
| 1104934892 | Serenity Lane | Substance Abuse Rehabilitation Facility | 1 Serenity Lane, Coburg, OR 97408 | 2006-08-25 |
| 1689115891 | Serenity Lane | Case Management | 601 Nw Harmon Blvd, Bend, OR 97703-3060 | 2017-03-20 |
| 1073060182 | Serenity Lane | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2016-09-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SERENITY LANE | 1 Serenity Lane, Coburg, OR 97408 |
| Oregon Corporations, Companies and Business Names | SERENITY LANE HEALTH SERVICES | 1 Serenity Lane, Coburg, OR 97408 |
| Oregon Corporations, Companies and Business Names | SERENITY LANE HEALTH SERVICES FOUNDATION | 1 Serenity Lane, Coburg, OR 97408 |
| Street Address |
2575 NW KLINE ST |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-8827 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114530193 | Lydia Corine Meyer | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2020-08-28 |
| 1316594427 | Todd Allyn Bryson | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2019-08-22 |
| 1477109122 | Michelle Wissel | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2019-08-16 |
| 1962058883 | Samantha Hardy | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2019-08-15 |
| 1326568189 | George Charles Spurny | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2017-06-22 |
| 1972053205 | Anthony Haynes | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2016-10-11 |
| 1073060182 | Serenity Lane | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2016-09-07 |
| 1467905489 | Kay Tanner | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2016-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306205984 | Susan Anne Dowell | Counselor | 548 Se Jackson Street, Roseburg, OR 97470-0254 | 2016-02-11 |
| 1528426517 | William C. Poulter | Counselor | 548 Sw Jackson St, Roseburg, OR 97470-2709 | 2016-02-04 |
| 1508295668 | Adapt | Counselor | 1215 Se Court Ave, Roseburg, OR 97470-4329 | 2013-11-08 |
| 1174952238 | Adapt | Counselor | 550 Se Jackson St, Roseburg, OR 97470-4923 | 2013-11-08 |
| 1639508708 | Adapt | Counselor | 1036 Se Douglas Ave, Roseburg, OR 97470-3301 | 2013-11-08 |
| 1245597582 | Alison Marie Hinson | Counselor | 850 Se Rose St, Roseburg, OR 97470-3942 | 2012-04-11 |
| 1114112133 | Delila S Donaldson | Counselor | 727 Se Cass Ave Ste 223, Roseburg, OR 97470-4953 | 2007-09-12 |
| 1639256431 | Linda Witbeck | Counselor | 913 Garden Valley Blvd, Bldg 2, Ward 2, Sartp, Roseburg, OR 97470 | 2006-11-01 |
| 1750373346 | Adapt | Counselor | 548 Se Jackson St, Roseburg, OR 97470-4983 | 2005-08-18 |
| 1861092645 | Joseph T Mitchell | Counselor | 3099 Ne Diamond Lake Blvd, Roseburg, OR 97470-3655 | 2020-10-29 |
| Find all providers in ROSEBURG | ||||
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| 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.