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General NPI Number Information
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NPI Number | 1811746209
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Entity Type | Organization
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Legal Business Name | SERENITY CARE MANOR
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1833 KOLOB DR
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City | FAIRFIELD
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State | CA
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Zip | 94534-2924
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Country | US
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Telephone | 510-965-8350
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Fax |
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Provider Business Mailing Address
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Address Line | 13904 CARDIGAN AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93314-8994
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Country | US
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Telephone | 510-965-8350
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Fax | 651-855-5056
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EMMANUEL PATRICIO SALAS
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Credential | RCFE ADMINISTRATOR
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Telephone | 510-965-8350
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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 |
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License Number State |
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