Healthcare Provider Details

I. General information

NPI: 1245623156
Provider Name (Legal Business Name): SERENITY CARE HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 11/07/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E ANAHEIM ST
LONG BEACH CA
90813
US

IV. Provider business mailing address

515 S FLOWER ST FL 18
LOS ANGELES CA
90071-2201
US

V. Phone/Fax

Practice location:
  • Phone: 562-478-4102
  • Fax: 562-684-0866
Mailing address:
  • Phone: 562-478-4102
  • Fax: 562-684-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA61959
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE ODIAKA OGBECHIE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 213-478-0737