1003212010 NPI number — SERENITY HOSPICE CARE PROVIDER, INC.

Table of content: LISA FAYE BARRETT DO (NPI 1497314637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003212010 NPI number — SERENITY HOSPICE CARE PROVIDER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY HOSPICE CARE PROVIDER, INC.
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:
6
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:
1003212010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2139 TAPO ST
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93063-3478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-522-5506
Provider Business Mailing Address Fax Number:
800-315-9134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2139 TAPO ST STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93063-3476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-522-5506
Provider Business Practice Location Address Fax Number:
800-315-9134
Provider Enumeration Date:
11/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
THONA
Authorized Official First Name:
MAYA
Authorized Official Middle Name:
MELLINA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
714-606-7986

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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