| Serenity Lane | |
|
2575 Nw Kline St Roseburg OR 97471-8827 | |
| (541) 673-3504 | |
| (541) 673-4724 |
| Full Name | Serenity Lane |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2575 Nw Kline St, Roseburg, Oregon |
| Authorized Official Name and Position | Anthony William Haynes (PROGRAM COORDINATOR) |
| Authorized Official Contact | 5416733504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Lane 2575 Nw Kline St Roseburg OR 97471-8827 Ph: (541) 673-3504 | Serenity Lane 2575 Nw Kline St Roseburg OR 97471-8827 Ph: (541) 673-3504 |
| NPI Number | 1073060182 |
|---|---|
| Provider Enumeration Date | 09/07/2016 |
| Last Update Date | 09/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073060182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 13-12-59 (Oregon) | Primary |
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