Provider Demographics
NPI:1669502142
Name:SERENITY INFANT CARE HOMES
Entity Type:Organization
Organization Name:SERENITY INFANT CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOCTOW
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:626-859-6200
Mailing Address - Street 1:600 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3638
Mailing Address - Country:US
Mailing Address - Phone:626-859-6200
Mailing Address - Fax:626-938-0397
Practice Address - Street 1:600 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3638
Practice Address - Country:US
Practice Address - Phone:626-859-6200
Practice Address - Fax:626-938-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000007544Medicaid
CA7544AMedicaid