1205787108 NPI number — SERENE VALLEY HEALTHCARE, LLC

Table of content: (NPI 1205787108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205787108 NPI number — SERENE VALLEY HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENE VALLEY HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205787108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4837 E MCKINLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93703-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-492-2876
Provider Business Mailing Address Fax Number:
559-412-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4837 E MCKINLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93703-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-492-2876
Provider Business Practice Location Address Fax Number:
559-412-7642
Provider Enumeration Date:
02/05/2026

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOR
Authorized Official First Name:
KIYA
Authorized Official Middle Name:
NKAUJNOOG
Authorized Official Title or Position:
OWNER/MEMBERS
Authorized Official Telephone Number:
559-417-1795

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)