Provider Demographics
NPI:1699130351
Name:SERENITY CARE CENTER, LLC
Entity type:Organization
Organization Name:SERENITY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-247-1428
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13951 W MEEKER BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4424
Practice Address - Country:US
Practice Address - Phone:602-833-8438
Practice Address - Fax:623-533-5855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-23
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZIFBH7647324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH4989OtherAZ DOH
AZIFBH7647OtherAZ DEPARTMENT OF HEALTH SERVCIES
AZBH4988OtherAZ DOH