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General NPI Number Information
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NPI Number | 1043104276
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Entity Type | Organization
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Legal Business Name | SERENITY HAVEN HOSPICE CARE LLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 974 KLONDIKE CT SW STE 102
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City | CONYERS
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State | GA
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Zip | 30094-5185
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Country | US
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Telephone | 855-742-2732
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Fax | 866-525-0411
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Provider Business Mailing Address
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Address Line | 2324 NEW HAVEN PL
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City | CONYERS
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State | GA
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Zip | 30094-3380
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Country | US
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Telephone | 404-281-3306
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CANDACE BUTTS
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Credential | RN
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Telephone | 404-281-3306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number |
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License Number State |
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