MEDICARE: SERENE CENTER, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1447494380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE CENTER, INC.

Provider Business Mailing Address
First Line	:	1215 E 4TH ST
Second Line	:	STE 102
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7518
Country	:	US
Telephone Number	:	562-366-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 E 4TH ST
Second Line	:	STE 102
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7518
Country	:	US
Telephone Number	:	562-366-3557
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDREW T MARTIN
Credential	:	MBA, CADC I
Telephone Number	:	562-366-3557

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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