MEDICARE: LOVE AND SERENITY 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1639677842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE AND SERENITY LLC

Provider Business Mailing Address
First Line	:	57 FARALLON CIR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3726
Country	:	US
Telephone Number	:	916-821-4423
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 FARALLON CIR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3726
Country	:	US
Telephone Number	:	916-821-4423
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MARK LABELLA
Credential	:
Telephone Number	:	916-821-4423

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	03/17/2018

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