Provider Demographics
NPI:1902650732
Name:A SERENE SENIOR LIVING LLC
Entity Type:Organization
Organization Name:A SERENE SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:BANZALI
Authorized Official - Last Name:SANSANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-295-6854
Mailing Address - Street 1:6 WILLOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5551
Mailing Address - Country:US
Mailing Address - Phone:949-295-6854
Mailing Address - Fax:949-742-6355
Practice Address - Street 1:24562 DARDANIA AVE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4623
Practice Address - Country:US
Practice Address - Phone:949-295-6854
Practice Address - Fax:949-742-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility