Provider Demographics
NPI:1922415710
Name:SERENITY HOSPICE OF CLAREMORE
Entity Type:Organization
Organization Name:SERENITY HOSPICE OF CLAREMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-782-1414
Mailing Address - Street 1:35904 S HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-6743
Mailing Address - Country:US
Mailing Address - Phone:918-782-1414
Mailing Address - Fax:918-782-1415
Practice Address - Street 1:35904 S HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-6743
Practice Address - Country:US
Practice Address - Phone:918-782-1414
Practice Address - Fax:918-782-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4246251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1215983291Medicare NSC