- Enrollment id
- O20110620000594
- Enrollment state
- OR
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1174561849
- Multiple npi flag
- N
- Ccn
- 381555
- Associate id
- 8527246644
- Organization name
- SERENITY PALLIATIVE CARE AND HOSPICE LLC
- Doing business as name
- SERENITY HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 11481 SW HALL BLVD
- Address line 2
- STE 200
- City
- TIGARD
- State
- OR
- Zip code
- 972238403