| Organization Name: | SERENDIPITY MOUNTAIN LODGE |
| NPI Number: | 1649663436 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUDITH MILLER (CEO) |
| Mailing Address: | 41250 Alford Rd Simla |
| State: | CO US |
| Postal Code: | 808359607 |
| Phone Number: | 7195414912 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2015 |
| NPI Last Update Date: | 03/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |