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General NPI Number Information
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NPI Number | 1730419722
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Entity Type | Organization
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Legal Business Name | SERENITY PREMIER HOSPICE, LLC
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 1905 MISSION 66 # B SUITE 1
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City | VICKSBURG
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State | MS
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Zip | 39180-3751
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Country | US
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Telephone | 601-661-9752
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Fax | 601-661-6021
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Provider Business Mailing Address
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Address Line | PO BOX 820472
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City | VICKSBURG
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State | MS
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Zip | 39182-0472
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Country | US
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Telephone | 601-661-9752
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Fax | 601-661-6021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOYCE BLUE
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Credential |
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Telephone | 601-661-9752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | MS
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