Healthcare Provider Details

I. General information

NPI: 1043169626
Provider Name (Legal Business Name): SERENITY VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 SE MONTEREY AVE
HAPPY VALLEY OR
97086-7509
US

IV. Provider business mailing address

15813 72ND AVE FL 2
FRESH MEADOWS NY
11365-4100
US

V. Phone/Fax

Practice location:
  • Phone: 503-526-8377
  • Fax: 503-526-8377
Mailing address:
  • Phone: 503-526-8377
  • Fax: 503-526-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER FOSTER
Title or Position: CEO
Credential:
Phone: 716-819-0392