Provider Demographics
NPI:1114024221
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 1:206 S MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 S MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2526
Practice Address - Country:US
Practice Address - Phone:205-459-4080
Practice Address - Fax:205-459-4090
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
AL011633251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1633EMedicaid
ALPIC1633EMedicaid