Healthcare Provider Details

I. General information

NPI: 1578428199
Provider Name (Legal Business Name): SERENITY CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 AVALON WAY
LEMON GROVE CA
91945-3447
US

IV. Provider business mailing address

7484 UNIVERSITY AVE STE 330
LA MESA CA
91942-6065
US

V. Phone/Fax

Practice location:
  • Phone: 619-750-8500
  • Fax:
Mailing address:
  • Phone: 619-750-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ABDIKARIM A HUSSEIN
Title or Position: CEO
Credential: ADMINISTRATOR
Phone: 619-750-8500