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SERENE HAVEN LLC
NPI 1073493532
Assisted Living Facility in Plymouth, MN

Active since September 05, 2025CLIA 24D2341311 · Waiver
4050 NATHAN LN N, PLYMOUTH, MN 55441(651) 204-9932 Get Directions Write a Review

NPPES record last updated: September 5, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Serene Haven Llc NPPES

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

SERENE HAVEN LLC (NPI 1073493532) is a healthcare organization registered as an assisted living facility in Plymouth, Minnesota and active in the NPI registry since September 2025. The organization holds a CLIA Waiver certificate valid through March 30, 2028 and lists Jennifer Ogbogu, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1073493532
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSERENE HAVEN LLC
Location Address4050 NATHAN LN NPlymouth, MN 55441-1630
Mailing Address4050 Nathan Ln NPlymouth, MN 55441-1630 · (651) 204-9932
Phone(651) 204-9932
Organization SubpartNo
Authorized OfficialJennifer OgboguAuthorized Official · (612) 987-3030
Enumeration DateSeptember 5, 2025
NPPES CertifiedSeptember 5, 2025
✔ NPI 1073493532 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
4050 NATHAN LN N, Plymouth, MN 55441
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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 24D2341311

Serene Haven LLC · Plymouth, MN
Active · expires Mar 30, 2028
CLIA Number24D2341311
Laboratory TypeAssisted Living Facility
Certificate Effective DateMarch 31, 2026
Certificate Expiration DateMarch 30, 2028
Laboratory DirectorKene G. Ogbogu
Laboratory Phone(651) 204-9932
Laboratory LocationSerene Haven LLC4050 Nathan Ln N, Plymouth, MN 55441
CLIA data matches this NPI record on: Address Name Phone
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 Serene Haven LLC's NPI number?

The NPI number for Serene Haven LLC is 1073493532. It was assigned to this organization in the NPPES registry on September 5, 2025.

Where is Serene Haven LLC located?

Serene Haven LLC is located at 4050 Nathan Ln N, Plymouth, MN 55441. The listed phone number is (651) 204-9932.

What is Serene Haven LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Serene Haven LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2341311) is associated with this NPI, valid through March 30, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Serene Haven LLC was last updated on September 5, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.