MEDICARE: SERENITY HOSPICE OF MICHIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1417323098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOSPICE OF MICHIGAN

Provider Business Mailing Address
First Line	:	5366 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6942 DIXIE HWY
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9760
Country	:	US
Telephone Number	:	734-644-0303
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR, OWNER
Name	:	MR. KHIZER SIKANDER
Credential	:
Telephone Number	:	734-644-0303

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	08/18/2015

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