MEDICARE: SERENITY VILLAGE 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1821987215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY VILLAGE LLC

Provider Business Mailing Address
First Line	:	2566 BARTEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3522
Country	:	US
Telephone Number	:	858-256-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 BARTEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3522
Country	:	US
Telephone Number	:	858-436-4845
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIAMOND AHMED
Credential	:
Telephone Number	:	858-436-4845

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	01/07/2026

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Directions to “SERENITY VILLAGE LLC ” Practice Location

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