Provider Demographics
NPI:1376897025
Name:SERENITY PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:SERENITY PALLIATIVE CARE LLC
Other - Org Name:CANYON PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:450 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2983
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:7878 N 16TH ST STE 155
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4470
Practice Address - Country:US
Practice Address - Phone:602-314-6246
Practice Address - Fax:602-443-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management