Provider Demographics
NPI:1104001346
Name:ARIZONA SENIOR SERVICES, LLC
Entity Type:Organization
Organization Name:ARIZONA SENIOR SERVICES, LLC
Other - Org Name:SERENITY II ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-205-1764
Mailing Address - Street 1:6796 S PIGEONBERRY PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5149
Mailing Address - Country:US
Mailing Address - Phone:520-205-1764
Mailing Address - Fax:
Practice Address - Street 1:5601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3224
Practice Address - Country:US
Practice Address - Phone:520-514-9377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-6472310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility