Provider Demographics
NPI:1043953714
Name:SERENA ADULT DAY CENTER
Entity Type:Organization
Organization Name:SERENA ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:YASIN
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:614-599-3206
Mailing Address - Street 1:405 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1032
Mailing Address - Country:US
Mailing Address - Phone:612-435-4693
Mailing Address - Fax:612-435-5667
Practice Address - Street 1:405 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1032
Practice Address - Country:US
Practice Address - Phone:612-315-4693
Practice Address - Fax:612-435-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1112071Medicaid