Provider Demographics
NPI:1356836480
Name:SERENITY DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:SERENITY DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STRINGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-903-3067
Mailing Address - Street 1:6204 MARY JEAN PL
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6111
Mailing Address - Country:US
Mailing Address - Phone:916-903-3067
Mailing Address - Fax:
Practice Address - Street 1:6204 MARY JEAN PL
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6111
Practice Address - Country:US
Practice Address - Phone:916-903-3067
Practice Address - Fax:916-290-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201816310597261QS1200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No291U00000XLaboratoriesClinical Medical Laboratory