Provider Demographics
NPI:1730464033
Name:SERENITY CARE HOSPICE INC
Entity type:Organization
Organization Name:SERENITY CARE HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-328-6914
Mailing Address - Street 1:811 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1784
Mailing Address - Country:US
Mailing Address - Phone:816-380-3913
Mailing Address - Fax:816-380-3912
Practice Address - Street 1:811 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1784
Practice Address - Country:US
Practice Address - Phone:816-380-3913
Practice Address - Fax:816-380-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO163WH1000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261648Medicare Oscar/Certification