- Enrollment id
- O20230524002969
- Enrollment state
- UT
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1194426791
- Multiple npi flag
- N
- Ccn
- 461635
- Associate id
- 8325404924
- Organization name
- SERENITY HOSPICE OF UTAH LLC
- Incorporation date
- 2023-03-09
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 627 W 4000 N
- City
- PLEASANT GROVE
- State
- UT
- Zip code
- 840628754