MEDICARE: SERENITY HOME HOSPICE 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

General Provider Information

NPI Number	:	1417113150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HOME HOSPICE LLC

Provider Business Mailing Address
First Line	:	2131 E 2100 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1128
Country	:	US
Telephone Number	:	801-598-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 E 2100 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1128
Country	:	US
Telephone Number	:	801-598-2586
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VERONICA HANSEN
Credential	:
Telephone Number	:	801-487-2006

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	10/29/2008

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