Provider Demographics
NPI:1043104276
Name:SERENITY HAVEN HOSPICE CARE LLC
Entity type:Organization
Organization Name:SERENITY HAVEN HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-281-3306
Mailing Address - Street 1:2324 NEW HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3380
Mailing Address - Country:US
Mailing Address - Phone:404-281-3306
Mailing Address - Fax:
Practice Address - Street 1:974 KLONDIKE CT SW STE 102
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5185
Practice Address - Country:US
Practice Address - Phone:855-742-2732
Practice Address - Fax:866-525-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty