- Enrollment id
- O20220513001759
- Enrollment state
- MO
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1194478172
- Multiple npi flag
- N
- Ccn
- 261671
- Associate id
- 9638556582
- Organization name
- SERENITY HOSPICE, LLC
- Incorporation date
- 2022-01-27
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 301 SOVEREIGN CT
- Address line 2
- STE 209
- City
- BALLWIN
- State
- MO
- Zip code
- 630114435