Provider Demographics
NPI:1053316091
Name:SERENITY HOSPICECARE
Entity Type:Organization
Organization Name:SERENITY HOSPICECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-431-0162
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:5272 FLAT RIVER RD MINERAL AREA COLLEGE
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-1000
Mailing Address - Country:US
Mailing Address - Phone:573-431-0162
Mailing Address - Fax:573-431-6304
Practice Address - Street 1:5272 FLAT RIVER RD
Practice Address - Street 2:MINERAL AREA COLLEGE
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-1000
Practice Address - Country:US
Practice Address - Phone:573-431-0162
Practice Address - Fax:573-431-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO827876400Medicaid
26-1554Medicare ID - Type Unspecified