Provider Demographics
NPI:1710640263
Name:SERENITY ASSISTED LIVING
Entity Type:Organization
Organization Name:SERENITY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIEYRA AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-653-7912
Mailing Address - Street 1:3879 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3821
Mailing Address - Country:US
Mailing Address - Phone:909-653-7912
Mailing Address - Fax:951-729-6156
Practice Address - Street 1:3879 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3821
Practice Address - Country:US
Practice Address - Phone:909-653-7912
Practice Address - Fax:951-729-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility