Provider Demographics
NPI:1124030135
Name:SERENITY PALLIATIVE AND HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:SERENITY PALLIATIVE AND HOSPICE CARE, INC.
Other - Org Name:SERENITY PALLIATIVE & HOSPICE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:KIRT
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-644-5134
Mailing Address - Street 1:141 VILLAGE PARKWAY, NE
Mailing Address - Street 2:BUILDING 5-A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4067
Mailing Address - Country:US
Mailing Address - Phone:770-790-4146
Mailing Address - Fax:770-955-3077
Practice Address - Street 1:325 SOUTH OAKLAND AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4573
Practice Address - Country:US
Practice Address - Phone:803-817-1733
Practice Address - Fax:803-817-1744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY PALLIATIVE AND HOSPICE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-099251G00000X
SCHPC-0099251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP070Medicaid
SCHSP070Medicaid