Provider Demographics
NPI:1245623156
Name:SERENITY CARE HEALTH GROUP
Entity type:Organization
Organization Name:SERENITY CARE HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ODIAKA
Authorized Official - Last Name:OGBECHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-478-0737
Mailing Address - Street 1:515 S FLOWER ST FL 18
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2201
Mailing Address - Country:US
Mailing Address - Phone:562-478-4102
Mailing Address - Fax:562-684-0866
Practice Address - Street 1:1930 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-478-4102
Practice Address - Fax:562-684-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LP2300X, 111N00000X, 171100000X, 261QF0400X
CAA619592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619590Medicaid
CAG47739Medicare PIN
CA00A619590Medicaid