Provider Demographics
NPI:1346071701
Name:SOUTH BAY SERENITY INC
Entity type:Organization
Organization Name:SOUTH BAY SERENITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:ATIAGAN
Authorized Official - Last Name:AGATEP
Authorized Official - Suffix:
Authorized Official - Credentials:BS ACCOUNTING
Authorized Official - Phone:310-985-1059
Mailing Address - Street 1:1080 VIA LA PAZ
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-985-1059
Mailing Address - Fax:310-787-7303
Practice Address - Street 1:1080 VIA LA PAZ
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-985-1059
Practice Address - Fax:310-787-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility