MEDICARE: SERENE CENTER INC

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	251S00000X	Community/Behavioral Health Agency	190645AP	CA

General Provider Information

NPI Number	:	1932539657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE CENTER INC

Provider Business Mailing Address
First Line	:	1215 E 4TH ST STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7543
Country	:	US
Telephone Number	:	562-366-3557
Fax Number	:	562-366-3586

Provider Business Practice Location Address
First Line	:	1215 E 4TH ST STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7543
Country	:	US
Telephone Number	:	562-366-3557
Fax Number	:	562-366-3586

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW TERRY MARTIN
Credential	:	CADC II, SAP, CA-CCS
Telephone Number	:	562-366-3557

Provider Enumeration Date	:	11/15/2013
Last Update Date	:	11/15/2013

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