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General NPI Number Information
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NPI Number | 1821987215
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Entity Type | Organization
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Legal Business Name | SERENITY VILLAGE LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2566 BARTEL ST
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City | SAN DIEGO
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State | CA
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Zip | 92123-3522
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Country | US
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Telephone | 858-436-4845
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Fax |
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Provider Business Mailing Address
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Address Line | 2566 BARTEL ST
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City | SAN DIEGO
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State | CA
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Zip | 92123-3522
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Country | US
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Telephone | 858-256-0493
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIAMOND AHMED
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Credential |
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Telephone | 858-436-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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