Provider Demographics
NPI:1093975310
Name:SERENITY ASSISTED LIVING
Entity Type:Organization
Organization Name:SERENITY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:BUGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-505-3908
Mailing Address - Street 1:3677 BLUE COLT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-4273
Mailing Address - Country:US
Mailing Address - Phone:928-505-3908
Mailing Address - Fax:928-505-3908
Practice Address - Street 1:3677 BLUE COLT DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-4273
Practice Address - Country:US
Practice Address - Phone:928-505-3908
Practice Address - Fax:928-505-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5158310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility