Provider Demographics
NPI:1023527033
Name:SERENITY RECUPERATIVE CARE, INC
Entity type:Organization
Organization Name:SERENITY RECUPERATIVE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:310-493-2769
Mailing Address - Street 1:14608 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3258
Mailing Address - Country:US
Mailing Address - Phone:310-722-3707
Mailing Address - Fax:
Practice Address - Street 1:2125 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-1004
Practice Address - Country:US
Practice Address - Phone:562-588-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility