Healthcare Provider Details

I. General information

NPI: 1407620768
Provider Name (Legal Business Name): SERENE RELAXATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FAIR OAKS BLVD STE 303
CARMICHAEL CA
95608-1968
US

IV. Provider business mailing address

8300 FAIR OAKS BLVD STE 303
CARMICHAEL CA
95608-1968
US

V. Phone/Fax

Practice location:
  • Phone: 916-226-0527
  • Fax:
Mailing address:
  • Phone: 916-226-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAELYN CRENSHAW
Title or Position: CEO
Credential:
Phone: 916-226-0527