Provider Demographics
NPI:1003663089
Name:SERENE MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SERENE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-437-9070
Mailing Address - Street 1:2900 W CYPRESS CREEK RD STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-437-9070
Mailing Address - Fax:
Practice Address - Street 1:8080 PASADENA BLVD STE B
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3537
Practice Address - Country:US
Practice Address - Phone:954-437-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116261500Medicaid