{
  "npi": "1831014166",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "JESSE",
    "authorized_official_last_name": "KELLERT",
    "authorized_official_middle_name": "LEE",
    "authorized_official_telephone_number": "9492442279",
    "authorized_official_title_or_position": "CEO",
    "certification_date": "2026-08-05",
    "enumeration_date": "2026-08-13",
    "last_updated": "2026-08-13",
    "organization_name": "SERENITY LODGE INC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "SERENITY LODGE INC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 2895",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "LAKE ARROWHEAD",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "923522895",
      "state": "CA",
      "telephone_number": "949-244-2279"
    },
    {
      "address_1": "27175 STATE HIGHWAY 189",
      "address_2": "UNIT A",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BLUE JAY",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "92317",
      "state": "CA",
      "telephone_number": "949-244-2279"
    }
  ],
  "taxonomies": [
    {
      "code": "261QR0405X",
      "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "D5",
        "medicare_type": "Opioid Treatment Program"
      }
    ]
  }
}