Provider Demographics
NPI:1336865948
Name:SERENITY PREFERRED LLC
Entity Type:Organization
Organization Name:SERENITY PREFERRED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADARALEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-523-2297
Mailing Address - Street 1:23004 W HOPI ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8615
Mailing Address - Country:US
Mailing Address - Phone:623-523-2297
Mailing Address - Fax:
Practice Address - Street 1:23004 W HOPI ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8615
Practice Address - Country:US
Practice Address - Phone:623-523-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7928OtherAZDHS