Provider Demographics
NPI:1124724398
Name:SERENDIPITY IN THE SUN II LLC
Entity type:Organization
Organization Name:SERENDIPITY IN THE SUN II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALF MANAGER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CNL, CHC
Authorized Official - Phone:602-908-8580
Mailing Address - Street 1:10250 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10250 N 124TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5201
Practice Address - Country:US
Practice Address - Phone:602-859-3256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL12323HOtherARIZONA DEPARTMENT OF HEALTH SERVICES