Healthcare Provider Details

I. General information

NPI: 1750299244
Provider Name (Legal Business Name): ASPEN SERENITY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 CANTERBURY CT
UPLAND CA
91784-8923
US

IV. Provider business mailing address

326 CANTERBURY CT
UPLAND CA
91784-8923
US

V. Phone/Fax

Practice location:
  • Phone: 424-744-0604
  • Fax:
Mailing address:
  • Phone: 424-744-0604
  • Fax:

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: ALI ALKTAIFI
Title or Position: OWNER
Credential: MD
Phone: 818-428-8938