Provider Demographics
NPI:1316374408
Name:S&P GUPTA ENTERPRISE LLC
Entity Type:Organization
Organization Name:S&P GUPTA ENTERPRISE LLC
Other - Org Name:SERENITY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-988-1971
Mailing Address - Street 1:701 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3825
Mailing Address - Country:US
Mailing Address - Phone:512-985-6107
Mailing Address - Fax:512-379-7481
Practice Address - Street 1:701 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3825
Practice Address - Country:US
Practice Address - Phone:512-985-6107
Practice Address - Fax:512-379-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
741579Medicare Oscar/Certification