Provider Demographics
NPI:1275818965
Name:SERENITY HOSPICE HOME, INC
Entity Type:Organization
Organization Name:SERENITY HOSPICE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINONA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:318-664-0082
Mailing Address - Street 1:72 KING RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:DRY PRONG
Mailing Address - State:LA
Mailing Address - Zip Code:71423-8705
Mailing Address - Country:US
Mailing Address - Phone:318-664-0082
Mailing Address - Fax:
Practice Address - Street 1:72 KING RICHARD RD
Practice Address - Street 2:
Practice Address - City:DRY PRONG
Practice Address - State:LA
Practice Address - Zip Code:71423-8705
Practice Address - Country:US
Practice Address - Phone:318-664-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient