Serenity Ridge Palliative and Hospice Care

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SERENITY RIDGE PALLIATIVE AND HOSPICE CARE

Practice address

11239 Tampa Ave Ste 203
Porter Ranch, CA 91326-3784

Phone

(818) 217-4436

Fax

(818) 217-4336

NPI assigned

Dec 20, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Avo Krikor Harutunian

Title

Ceo/Cfo/Secretary

Phone

(818) 217-4436

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B21702

Legal name

SERENITY RIDGE PALLIATIVE AND HOSPICE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 16, 2021

Last certification

Aug 16, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Sep 26, 2019 in CA

Enrollment address

23505 Crenshaw Blvd
Ste 208
Torrance, CA 90505-5222

Listed as

Serenity Ridge Palliative and Hospice CareCCN B21702 · All quality measures

Ownership

For-Profit

Certified

Aug 16, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sultan Mohammad, MD

  • Family Medicine Physician
  • Buckeye, AZ
  • NPI 1760699888

  Contracted Managing Employee

  CMS ownership

Practitioners 1

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

• Sultan Mohammad, MD

  • Family Medicine Physician
  • Buckeye, AZ
  • NPI 1760699888
  NPD (past)

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1912545930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11239 TAMPA AVE STE 203",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913263784",
            "telephone_number": "818-217-4436",
            "fax_number": "818-217-4336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11239 TAMPA AVE STE 203",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913263784",
            "telephone_number": "818-217-4436",
            "fax_number": "818-217-4336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY RIDGE PALLIATIVE AND HOSPICE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "HARUTUNIAN",
        "authorized_official_first_name": "AVO",
        "authorized_official_middle_name": "KRIKOR",
        "authorized_official_title_or_position": "CEO/CFO/SECRETARY",
        "authorized_official_telephone_number": "818-217-4436",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanaa Saquib, PHARMD
• Alaleh Sareh, MD.
• Amrit Sekhon, FNP
• Renata Selak Stankovic, M.D.
• Mark Seo
• Jyotsna Sharma, M.B.B.S
• Steven Michael Shaw, LMFT 143909
• Sasha Bentciana Shenon, FNP-BC
• David Shin, M.D.
• Susan Shriver Rodnunsky, L.AC.

• Community Based Hospice Care Agency in Porter Ranch, CA
• Providers in Porter Ranch, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.