MEDICARE: LINDA M SERONEI ADMINISTRATOR

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1982336194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M SERONEI ADMINISTRATOR

Provider Business Mailing Address
First Line	:	2132 E KINGS AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2900
Country	:	US
Telephone Number	:	602-218-6562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 E KINGS AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2900
Country	:	US
Telephone Number	:	602-218-6562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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Directions to “ LINDA M SERONEI ADMINISTRATOR” Practice Location

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