Healthcare Provider Details

I. General information

NPI: 1528505302
Provider Name (Legal Business Name): THE SERENITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 BASELINE RD SUITE A-1
RANCHO CUCAMONGA CA
91701-5829
US

IV. Provider business mailing address

9320 BASELINE RD SUITE A-1
RANCHO CUCAMONGA CA
91701-5829
US

V. Phone/Fax

Practice location:
  • Phone: 909-652-2147
  • Fax:
Mailing address:
  • Phone: 909-652-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number20000023557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMY JEAN BELK
Title or Position: OWNER/OPERATOR
Credential:
Phone: 190-965-2147