1801313200 NPI number — SERENITY PALLIATIVE CARE AND HOSPICE, LLC

Table of content: (NPI 1801313200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801313200 NPI number — SERENITY PALLIATIVE CARE AND HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY PALLIATIVE CARE AND HOSPICE, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1801313200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6303 COWBOYS WAY STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-0329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-535-8200
Provider Business Mailing Address Fax Number:
205-379-6720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 GREEN ACRES RD STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97408-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
458-205-5166
Provider Business Practice Location Address Fax Number:
541-393-2296
Provider Enumeration Date:
08/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BICKHAM
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
PRESIDENT & COO
Authorized Official Telephone Number:
469-535-8200

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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