Provider Demographics
NPI:1689770166
Name:SERENE HOSPICE GROUP
Entity Type:Organization
Organization Name:SERENE HOSPICE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:SHIPP
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-745-0555
Mailing Address - Street 1:159 N CHURCH ST
Mailing Address - Street 2:POST OFFICE BOX 216
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3303
Mailing Address - Country:US
Mailing Address - Phone:662-745-0555
Mailing Address - Fax:662-745-0555
Practice Address - Street 1:159 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-3303
Practice Address - Country:US
Practice Address - Phone:662-745-0555
Practice Address - Fax:662-745-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS132251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based