Provider Demographics
NPI:1750422192
Name:SERENITY PALLIATIVE AND HOSPICE CARE
Entity type:Organization
Organization Name:SERENITY PALLIATIVE AND HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, OCN, CHPN
Authorized Official - Phone:803-817-1733
Mailing Address - Street 1:223 S HERLONG AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1670
Mailing Address - Country:US
Mailing Address - Phone:803-817-1733
Mailing Address - Fax:803-817-1744
Practice Address - Street 1:223 S HERLONG AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1670
Practice Address - Country:US
Practice Address - Phone:803-817-1733
Practice Address - Fax:803-817-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-099251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP070Medicaid
SCHSP070Medicaid