Healthcare Provider Details

I. General information

NPI: 1124431176
Provider Name (Legal Business Name): SERENDIPITY LIFESTYLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 06/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3693 E BART ST
GILBERT AZ
85295-4655
US

IV. Provider business mailing address

3693 E BART ST
GILBERT AZ
85295-4655
US

V. Phone/Fax

Practice location:
  • Phone: 480-747-0848
  • Fax:
Mailing address:
  • Phone: 480-747-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHHA6368
License Number StateAZ

VIII. Authorized Official

Name: TRACY SULZER
Title or Position: ADMINISTRATOR
Credential: RN,BSN,BHA
Phone: 480-747-0848