Healthcare Provider Details

I. General information

NPI: 1760889323
Provider Name (Legal Business Name): SERENITY CONGREGATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31730 AVENIDA DEL PADRE
CATHEDRAL CITY CA
92234
US

IV. Provider business mailing address

13331 MOORPARK ST. #127
SHERMAN OAKS CA
91423
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-8000
  • Fax: 760-321-8002
Mailing address:
  • Phone: 818-392-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. MICHELLE MAGHALYAN
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 818-392-0226