Provider Demographics
NPI:1508564642
Name:SERENE RESIDENTIAL CARE HOME LLC
Entity Type:Organization
Organization Name:SERENE RESIDENTIAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR FOR ASSISTED LIVING
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKISEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-283-8728
Mailing Address - Street 1:1848 CHATFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4239
Mailing Address - Country:US
Mailing Address - Phone:510-860-5725
Mailing Address - Fax:
Practice Address - Street 1:1848 CHATFIELD CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4239
Practice Address - Country:US
Practice Address - Phone:209-283-8728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility