Healthcare Provider Details

I. General information

NPI: 1417727751
Provider Name (Legal Business Name): SERENE FOUNTAINS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 N ALMA SCHOOL RD STE 110
CHANDLER AZ
85224-2487
US

IV. Provider business mailing address

2160 N ALMA SCHOOL RD STE 110
CHANDLER AZ
85224-2487
US

V. Phone/Fax

Practice location:
  • Phone: 623-213-5171
  • Fax:
Mailing address:
  • Phone: 623-213-5171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA DANIELS
Title or Position: OWNER
Credential:
Phone: 623-213-5171