1124030135 NPI number — SERENITY PALLIATIVE AND HOSPICE CARE, INC.

Table of content: (NPI 1124030135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124030135 NPI number — SERENITY PALLIATIVE AND HOSPICE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY PALLIATIVE AND HOSPICE CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SERENITY PALLIATIVE & HOSPICE CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124030135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 VILLAGE PARKWAY, NE
Provider Second Line Business Mailing Address:
BUILDING 5-A
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-4067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-790-4146
Provider Business Mailing Address Fax Number:
770-955-3077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 SOUTH OAKLAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-4573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-817-1733
Provider Business Practice Location Address Fax Number:
803-817-1744
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASH
Authorized Official First Name:
IAN
Authorized Official Middle Name:
KIRT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-644-5134

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HPC-099 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: HPC-0099 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HSP070 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com