MEDICARE: SERENITY HOSPICE CARE, LLC

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	25-1581	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073610218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOSPICE CARE, LLC

Provider Business Mailing Address
First Line	:	584 E MAIN ST STE B4
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2330
Country	:	US
Telephone Number	:	601-663-4126
Fax Number	:

Provider Business Practice Location Address
First Line	:	584 E MAIN ST STE B4
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2330
Country	:	US
Telephone Number	:	601-663-4126
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	KAREN DAREE BRELAND
Credential	:
Telephone Number	:	601-663-4126

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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