Healthcare Provider Details

I. General information

NPI: 1770043705
Provider Name (Legal Business Name): ESTANCIA SERENA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 929 KM 1.5 BO. LIRIOS BO. LIRIOS
JUNCOS PR
00777
US

IV. Provider business mailing address

PO BOX 555
JUNCOS PR
00777-0555
US

V. Phone/Fax

Practice location:
  • Phone: 787-333-6140
  • Fax:
Mailing address:
  • Phone: 787-333-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: NANCY CARRASCO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-333-6140