Provider Demographics
NPI:1528505302
Name:THE SERENITY CENTER
Entity type:Organization
Organization Name:THE SERENITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BELK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:190-965-2147
Mailing Address - Street 1:9320 BASELINE RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5829
Mailing Address - Country:US
Mailing Address - Phone:909-652-2147
Mailing Address - Fax:
Practice Address - Street 1:9320 BASELINE RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5829
Practice Address - Country:US
Practice Address - Phone:909-652-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CA200000235572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty