Provider Demographics
NPI:1801513254
Name:SERENE SURROUNDINGS BEHAVIORAL HOME 2, LLC
Entity type:Organization
Organization Name:SERENE SURROUNDINGS BEHAVIORAL HOME 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-298-7721
Mailing Address - Street 1:2304 W OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4165
Mailing Address - Country:US
Mailing Address - Phone:623-298-7721
Mailing Address - Fax:
Practice Address - Street 1:8517 S 55TH DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5224
Practice Address - Country:US
Practice Address - Phone:623-298-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENE SURROUNDINGS BEHAVIORAL HOME 1, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health