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General NPI Number Information
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NPI Number | 1487886248
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Entity Type | Organization
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Legal Business Name | SERENITY SENIORS HOME INC
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 217 S ESSEY AVE
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City | COMPTON
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State | CA
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Zip | 90221-3415
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Country | US
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Telephone | 310-763-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 217 S ESSEY AVE
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City | COMPTON
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State | CA
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Zip | 90221-3415
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Country | US
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Telephone | 310-763-7879
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Fax |
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Authorized Official
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Title or Position | RCFE ADMINSTRATOR
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Name | MAYA ASTIER
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Credential |
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Telephone | 310-763-7879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197607301
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License Number State | CA
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