Provider Demographics
NPI:1003946955
Name:SERENITY RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:SERENITY RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-368-0500
Mailing Address - Street 1:14512 CARFAX DR
Mailing Address - Street 2:APT. A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6230
Mailing Address - Country:US
Mailing Address - Phone:714-368-0500
Mailing Address - Fax:714-368-0545
Practice Address - Street 1:14512 CARFAX DR
Practice Address - Street 2:APT. A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6230
Practice Address - Country:US
Practice Address - Phone:714-368-0500
Practice Address - Fax:714-368-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300180AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility