Provider Demographics
NPI:1386340297
Name:SERENITY CARE CENTER LLC
Entity type:Organization
Organization Name:SERENITY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:612-242-0517
Mailing Address - Street 1:1601 MN-13 N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2172
Mailing Address - Country:US
Mailing Address - Phone:612-242-0517
Mailing Address - Fax:
Practice Address - Street 1:1601 MN-13E
Practice Address - Street 2:204
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2917
Practice Address - Country:US
Practice Address - Phone:612-242-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherAUTISM CENTER