Provider Demographics
NPI:1730419722
Name:SERENITY PREMIER HOSPICE, LLC
Entity type:Organization
Organization Name:SERENITY PREMIER HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-661-9752
Mailing Address - Street 1:PO BOX 820472
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39182-0472
Mailing Address - Country:US
Mailing Address - Phone:601-661-9752
Mailing Address - Fax:601-661-6021
Practice Address - Street 1:1905 MISSION 66 # B
Practice Address - Street 2:SUITE 1
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3751
Practice Address - Country:US
Practice Address - Phone:601-661-9752
Practice Address - Fax:601-661-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based