Provider Demographics
NPI:1013475854
Name:EAST VALLEY SERENITY HEALTH, LLC
Entity Type:Organization
Organization Name:EAST VALLEY SERENITY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINNI
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAVA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-770-4540
Mailing Address - Street 1:7030 S STAR DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4126
Mailing Address - Country:US
Mailing Address - Phone:480-770-4540
Mailing Address - Fax:480-420-3805
Practice Address - Street 1:4001 E BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2736
Practice Address - Country:US
Practice Address - Phone:480-770-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty