Serenity Care Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SERENITY CARE CENTER LLC

Practice address

1601 MN-13E
204
Burnsville, MN 55337-2917

Phone

(612) 242-0517

NPI assigned

Feb 2, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fadumo Mohamed Mohamed, OWNERNPI 1730869546

Title

Manager

Phone

(612) 242-0517

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fadumo Mohamed Mohamed

  • Behavior Technician
  • Rosemount, MN
  • NPI 1730869546
  NPD (past) Authorized official
• Basil Iqbal

  • Behavior Technician
  • Burnsville, MN
  • NPI 1841047933
  NPD
• Fardowso Mohamud

  • Behavior Technician
  • Burnsville, MN
  • NPI 1386489227
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1386340297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 MN-13 N",
            "address_2": "SUITE 204",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372172",
            "telephone_number": "612-242-0517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 MN-13E",
            "address_2": "204",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372917",
            "telephone_number": "612-242-0517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-02",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "FADUMO",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "612-242-0517",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AUTISM CENTER",
            "identifier": "=========",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Segar
• Dulce Segura Caudana, APRN
• James L Sehr
• Matthew Seitzer, MD
• Anah E. K. H. Sellers, M.S., PA-C
• McKenzie Paige Seubert
• Joseph Marconni Sewell Araya, MD
• Maryan Shafi
• Nasteho Shafi
• Rena Shah, MD

• Clinic/Center in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.