MEDICARE: SERENITY HOSPICE CARE PROVIDER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1003212010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOSPICE CARE PROVIDER, INC.

Provider Business Mailing Address
First Line	:	2139 TAPO ST
Second Line	:	STE 225
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3478
Country	:	US
Telephone Number	:	805-522-5506
Fax Number	:	800-315-9134

Provider Business Practice Location Address
First Line	:	2139 TAPO ST STE 212
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-522-5506
Fax Number	:	800-315-9134

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MAYA MELLINA THONA
Credential	:
Telephone Number	:	714-606-7986

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	04/13/2023

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