Provider Demographics
NPI:1104021609
Name:SERENITY PALLIATIVE AND HOSPICE CARE OF VALDOSTA, INC.
Entity Type:Organization
Organization Name:SERENITY PALLIATIVE AND HOSPICE CARE OF VALDOSTA, INC.
Other - Org Name:SERENITY PALLIATIVE AND HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:770-790-4146
Mailing Address - Street 1:1205 BAYTREE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2782
Mailing Address - Country:US
Mailing Address - Phone:229-241-8338
Mailing Address - Fax:229-241-8353
Practice Address - Street 1:1205 BAYTREE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2782
Practice Address - Country:US
Practice Address - Phone:229-241-8338
Practice Address - Fax:229-241-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18063OtherSTATE LICENSE
GA18063OtherSTATE LICENSE