MEDICARE: ARIZONA SERENITY CENTER LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1528874542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA SERENITY CENTER LLC

Provider Business Mailing Address
First Line	:	1221 E DRAKE DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-4725
Country	:	US
Telephone Number	:	602-677-2968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 E DRAKE DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-4725
Country	:	US
Telephone Number	:	602-677-2968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WAYNE BREWER
Credential	:
Telephone Number	:	602-334-8196

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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Directions to “ARIZONA SERENITY CENTER LLC ” Practice Location

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