Provider Demographics
NPI:1245847995
Name:SERENITY HOSPICE LA LLC
Entity type:Organization
Organization Name:SERENITY HOSPICE LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-849-0486
Mailing Address - Street 1:9800 S MONROE ST # 809
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4419
Mailing Address - Country:US
Mailing Address - Phone:818-945-1821
Mailing Address - Fax:213-451-3276
Practice Address - Street 1:2233 HONOLULU AVE UNIT 303
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1635
Practice Address - Country:US
Practice Address - Phone:818-945-1821
Practice Address - Fax:213-451-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based