MEDICARE: SERENITY CARE 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	IFBH7647	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH4989	OTHER	AZ	AZ DOH
2	IFBH7647	OTHER	AZ	AZ DEPARTMENT OF HEALTH SERVCIES
3	BH4988	OTHER	AZ	AZ DOH

General Provider Information

NPI Number	:	1699130351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 29650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13951 W MEEKER BLVD
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4424
Country	:	US
Telephone Number	:	602-833-8438
Fax Number	:	623-533-5855

Authorized Official
Title or Position	:	CHIEF REVENUE CYCLE OFFICER
Name	:	PAULA BEAN
Credential	:
Telephone Number	:	772-247-1428

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/22/2016

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Directions to “SERENITY CARE CENTER, LLC ” Practice Location

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