Provider Demographics
NPI:1730119017
Name:SERENITY PALLIATIVE AND HOSPICE CARE OF HILLENDALE, INC.
Entity Type:Organization
Organization Name:SERENITY PALLIATIVE AND HOSPICE CARE OF HILLENDALE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:KIRT
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-790-4146
Mailing Address - Street 1:2346 WISTERIA DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6174
Mailing Address - Country:US
Mailing Address - Phone:678-413-2222
Mailing Address - Fax:678-413-2221
Practice Address - Street 1:2346 WISTERIA DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6174
Practice Address - Country:US
Practice Address - Phone:678-413-2222
Practice Address - Fax:678-413-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0330248H251G00000X
GA033-0248-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA890472845AMedicaid
GA111653Medicare Oscar/Certification