Healthcare Provider Details

I. General information

NPI: 1720647183
Provider Name (Legal Business Name): SERENITY SPRINGS LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 BOLTON AVE
RIVERSIDE CA
92503-3151
US

IV. Provider business mailing address

9850 BOLTON AVE
RIVERSIDE CA
92503-3151
US

V. Phone/Fax

Practice location:
  • Phone: 951-300-2048
  • Fax: 951-300-2049
Mailing address:
  • Phone: 951-300-2048
  • Fax: 951-300-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ARIEL NORTH
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-300-2048