Provider Demographics
NPI:1376863795
Name:SERENE SLEEP MANAGEMENT, LLC
Entity Type:Organization
Organization Name:SERENE SLEEP MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-480-0150
Mailing Address - Street 1:8 BLUE PT
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4265
Mailing Address - Country:US
Mailing Address - Phone:949-480-0150
Mailing Address - Fax:949-315-3329
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:STE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-480-0150
Practice Address - Fax:949-315-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00OtherNA