Provider Demographics
NPI:1578362950
Name:SERENE LIVING SPECIALTY CARE LLC
Entity type:Organization
Organization Name:SERENE LIVING SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHAMED
Authorized Official - Middle Name:ABDULLAHI ALI
Authorized Official - Last Name:AFRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-471-4179
Mailing Address - Street 1:2670 KING AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4512
Mailing Address - Country:US
Mailing Address - Phone:612-471-4179
Mailing Address - Fax:
Practice Address - Street 1:2670 KING AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4512
Practice Address - Country:US
Practice Address - Phone:612-471-4179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center