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SERENITY LODGE, INC
NPI 1043780109
Substance Abuse Rehabilitation Facility in Lake Arrowhead, CA

Active since December 03, 2018CLIA 05D2073865 · Waiver
986 MEADOW BROOK ROAD, LAKE ARROWHEAD, CA 92352(909) 693-5127 Get Directions Write a Review

NPPES record last updated: December 3, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Serenity Lodge, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SERENITY LODGE, INC (NPI 1043780109) is a healthcare organization registered as a substance abuse rehabilitation facility in Lake Arrowhead, California and active in the NPI registry since December 2018. The organization holds a CLIA Waiver certificate valid through January 12, 2027 and lists Matthew Joseph Baldo, Compliance Manager, as its authorized official.

NPPES Registry Identity

NPI1043780109
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameSERENITY LODGE, INC
Location Address986 MEADOW BROOK ROADLake Arrowhead, CA 92352-9235
Mailing AddressPo Box 2895Lake Arrowhead, CA 92352-2895 · (909) 693-5127
Phone(909) 693-5127
Organization SubpartYes
Authorized OfficialMatthew Joseph BaldoCompliance Manager · (909) 693-5127
Enumeration DateDecember 3, 2018
✔ NPI 1043780109 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
986 MEADOW BROOK ROAD, Lake Arrowhead, CA 92352
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Other Identifiers 1

Other360091APCA · State License

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2073865

Serenity Lodge · Lake Arrowhead, CA
Active · expires Jan 12, 2027
CLIA Number05D2073865
Laboratory TypeComp. Outpatient Rehab Facility
Certificate Effective DateJanuary 13, 2025
Certificate Expiration DateJanuary 12, 2027
Laboratory DirectorValeh S. Karimkhani Do
Laboratory Phone(877) 379-4365
Laboratory LocationSerenity Lodge985 Meadow Brook Rd, Lake Arrowhead, CA 92352
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Serenity Lodge, Inc's NPI number?

The NPI number for Serenity Lodge, Inc is 1043780109. It was assigned to this organization in the NPPES registry on December 3, 2018.

Where is Serenity Lodge, Inc located?

Serenity Lodge, Inc is located at 986 Meadow Brook Road, Lake Arrowhead, CA 92352. The listed phone number is (909) 693-5127.

What is Serenity Lodge, Inc's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Serenity Lodge, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2073865) is associated with this NPI, valid through January 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Serenity Lodge, Inc was last updated on December 3, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.