SERENITY LODGE, INC (NPI# 1952871014) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952871014 |
| Entity Type | Organization |
| Organization Name | SERENITY LODGE, INC |
| Practice Address |
995 Meadow Brook Road Lake Arrowhead CA 92352 |
| Mailing Address |
Po Box 2895 Lake Arrowhead CA 92352-2895 |
| Practice Telephone | 9096935127 |
| Mailing Telephone | 9096935127 |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2018-12-03 |
| Authorized Official Name | MATTHEW JOSEPH BALDO (COMPLIANCE MANAGER) |
| Authorized Official Telephone | 9096935127 |
| Is Organization Subpart | Y |
| Parent Organization Name | SERENITY LODGE, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134699291 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 974 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1043780109 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 986 Meadow Brook Road, Lake Arrowhead, CA 92352-9235 | 2018-12-03 |
| 1598235657 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1010 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1144790379 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 977 Meadow Brook Rd, Lake Arrowhead, CA 92352-9235 | 2018-11-30 |
| 1932674363 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 27438 Nancy Drive, Lake Arrowhead, CA 92352 | 2018-10-12 |
| 1992294813 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1000 Pine Court, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1629567573 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1032 Cedar Lane, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1184914590 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 985 Meadow Brook Rd, Lake Arrowhead, CA 92352 | 2011-04-19 |
| Street Address |
995 MEADOW BROOK ROAD |
| City | LAKE ARROWHEAD |
| State | CA |
| Zip Code | 92352 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952861239 | Elizabeth Kathleen White | Psychologist | 27307 State Hwy 189, #102, Lake Arrowhead, CA 92352 | 2019-03-22 |
| 1134699291 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 974 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1598235657 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1010 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1932674363 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 27438 Nancy Drive, Lake Arrowhead, CA 92352 | 2018-10-12 |
| 1992294813 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1000 Pine Court, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1629567573 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1032 Cedar Lane, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1730638925 | Lake Arrowhead Recovery Center | Substance Abuse Rehabilitation Facility | 28729 Palisades Drive, Lake Arrowhead, CA 92352 | 2016-09-28 |
| 1366803140 | Carolyn Burnham | Registered Nurse | 157 Brentwood Drive, Lake Arrowhead, CA 92352 | 2016-03-08 |
| 1508226994 | Lisa Lynne Hower | Counselor | 26166 Circle Drive, Lake Arrowhead, CA 92352 | 2016-02-29 |
| 1952731747 | Daniel Peter Calabrese | Radiology | 1287 Innsbruck Drive, Lake Arrowhead, CA 92352 | 2013-11-15 |
| Find all providers in zip 92352 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134699291 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 974 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1043780109 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 986 Meadow Brook Road, Lake Arrowhead, CA 92352-9235 | 2018-12-03 |
| 1598235657 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1010 Meadow Brook Road, Lake Arrowhead, CA 92352 | 2018-12-03 |
| 1144790379 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 977 Meadow Brook Rd, Lake Arrowhead, CA 92352-9235 | 2018-11-30 |
| 1932674363 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 27438 Nancy Drive, Lake Arrowhead, CA 92352 | 2018-10-12 |
| 1992294813 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1000 Pine Court, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1629567573 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 1032 Cedar Lane, Lake Arrowhead, CA 92352 | 2018-05-07 |
| 1730638925 | Lake Arrowhead Recovery Center | Substance Abuse Rehabilitation Facility | 28729 Palisades Drive, Lake Arrowhead, CA 92352 | 2016-09-28 |
| 1124435755 | Refuge Inc | Substance Abuse Rehabilitation Facility | 1366 Yellowstone Dr, Lake Arrowhead, CA 92352-1238 | 2014-07-15 |
| 1184914590 | Serenity Lodge, Inc | Substance Abuse Rehabilitation Facility | 985 Meadow Brook Rd, Lake Arrowhead, CA 92352 | 2011-04-19 |
| Find all providers in LAKE ARROWHEAD | ||||
| City | LAKE ARROWHEAD |
| Zip Code | 92352 |
Please comment or provide details below to improve the information on SERENITY LODGE, INC.
| 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.