Provider Demographics
NPI:1073610218
Name:SERENITY HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:SERENITY HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DAREE
Authorized Official - Last Name:BRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-663-4126
Mailing Address - Street 1:584 E MAIN ST STE B4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2330
Mailing Address - Country:US
Mailing Address - Phone:601-663-4126
Mailing Address - Fax:
Practice Address - Street 1:584 E MAIN ST STE B4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2330
Practice Address - Country:US
Practice Address - Phone:601-663-4126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25-1581251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08639050Medicaid
MS08639050Medicaid