Healthcare Provider Details

I. General information

NPI: 1902650732
Provider Name (Legal Business Name): A SERENE SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24562 DARDANIA AVE
MISSION VIEJO CA
92691-4623
US

IV. Provider business mailing address

6 WILLOWBROOK LN
RANCHO SANTA MARGARITA CA
92688-5551
US

V. Phone/Fax

Practice location:
  • Phone: 949-295-6854
  • Fax: 949-742-6355
Mailing address:
  • Phone: 949-295-6854
  • Fax: 949-742-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MINERVA BANZALI SANSANO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 949-295-6854