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General NPI Number Information
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NPI Number | 1811867591
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Entity Type | Organization
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Legal Business Name | SERENITY VILLA JJA, INC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1036 VIA LA PAZ
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City | SAN PEDRO
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State | CA
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Zip | 90732-2307
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Country | US
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Telephone | 310-935-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 VIA LA PAZ
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City | SAN PEDRO
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State | CA
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Zip | 90732-2307
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Country | US
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Telephone | 310-935-2662
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EVELYN BANARES ESPIRITU
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Credential |
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Telephone | 424-376-9030
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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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