MEDICARE: DIVINE SERENITY FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse

General Provider Information

NPI Number	:	1295677391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE SERENITY FOUNDATION

Provider Business Mailing Address
First Line	:	26625 ROUNDUP WAY
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-0542
Country	:	US
Telephone Number	:	323-360-3779
Fax Number	:

Provider Business Practice Location Address
First Line	:	26625 ROUNDUP WAY
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-0542
Country	:	US
Telephone Number	:	323-360-3779
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LETRICIA LADIAMOND WALTON
Credential	:	LVN
Telephone Number	:	323-360-3779

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “DIVINE SERENITY FOUNDATION ” Practice Location

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