Provider Demographics
NPI:1902551914
Name:SERENDIPITY IN THE SUN LLC
Entity Type:Organization
Organization Name:SERENDIPITY IN THE SUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ ALF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, MSN, BSN-RN, BA
Authorized Official - Phone:602-908-8580
Mailing Address - Street 1:6501 E CORRINE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4560
Mailing Address - Country:US
Mailing Address - Phone:480-761-1778
Mailing Address - Fax:480-350-7733
Practice Address - Street 1:6501 E CORRINE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4560
Practice Address - Country:US
Practice Address - Phone:480-761-1778
Practice Address - Fax:480-350-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL11590HOtherARIZONA DEPARTMENT OF HEALTH SERVICES