Healthcare Provider Details

I. General information

NPI: 1730464033
Provider Name (Legal Business Name): SERENITY CARE HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WESTCHESTER AVE
HARRISONVILLE MO
64701-1784
US

IV. Provider business mailing address

1175 CENTRE POINTE CIR
MENDOTA HEIGHTS MN
55120-5500
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3913
  • Fax: 816-380-3912
Mailing address:
  • Phone: 651-328-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number StateMO

VIII. Authorized Official

Name: STEPHEN PHENNEGER
Title or Position: CFO AND PRESIDENT
Credential:
Phone: 612-544-6133