Provider Demographics
NPI:1376097923
Name:SERENITY GARDENS REHAB
Entity Type:Organization
Organization Name:SERENITY GARDENS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-520-9148
Mailing Address - Street 1:678 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2734
Mailing Address - Country:US
Mailing Address - Phone:650-520-9148
Mailing Address - Fax:
Practice Address - Street 1:5830 COHASSET WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3710
Practice Address - Country:US
Practice Address - Phone:650-520-9148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility